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30–792 PDF 2006

S. HRG. 109–670

MEETING THE HOUSING

AND SERVICE NEEDS OF SENIORS

HEARING

BEFORE THE

COMMITTEE ON

BANKING, HOUSING, AND URBAN AFFAIRS

UNITED STATES SENATE

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

ON

EXAMINATION OF S. 705, TO ESTABLISH THE INTERAGENCY COUNCIL

ON MEETING THE HOUSING AND SERVICE NEEDS OF SENIORS

JUNE 16, 2005

Printed for the use of the Committee on Banking, Housing, and Urban Affairs

(

Available at: http://www.access.gpo.gov/congress/senate/senate05sh.html

COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS

RICHARD C. SHELBY, Alabama, Chairman

ROBERT F. BENNETT, Utah

WAYNE ALLARD, Colorado

MICHAEL B. ENZI, Wyoming

CHUCK HAGEL, Nebraska

RICK SANTORUM, Pennsylvania

JIM BUNNING, Kentucky

MIKE CRAPO, Idaho

JOHN E. SUNUNU, New Hampshire

ELIZABETH DOLE, North Carolina

MEL MARTINEZ, Florida

PAUL S. SARBANES, Maryland

CHRISTOPHER J. DODD, Connecticut

TIM JOHNSON, South Dakota

JACK REED, Rhode Island

CHARLES E. SCHUMER, New York

EVAN BAYH, Indiana

THOMAS R. CARPER, Delaware

DEBBIE STABENOW, Michigan

ROBERT MENENDEZ, New Jersey

KATHLEEN L. CASEY, Staff Director and Counsel

STEVEN B. HARRIS, Democratic Staff Director and Chief Counsel

MARK A. CALABRIA, Senior Professional Staff Member

TEWANA WILKERSON, Legislative Assistant

JONATHAN MILLER, Democratic Professional Staff

JENNIFER FOGEL-BUBLICK, Democratic Counsel

SARAH GARRETT, Democratic Legislative Assistant

KARA STEIN, Democratic Legal Counsel

JOSEPH R. KOLINSKI, Chief Clerk and Computer Systems Administrator

GEORGE E. WHITTLE, Editor

(II)

CONTENTS

THURSDAY, JUNE 16, 2005

Page

Opening statement of Chairman Shelby ................................................................ 1

Opening statements, comments, or prepared statements of:

Senator Sarbanes .............................................................................................. 2

Senator Allard ................................................................................................... 4

Senator Santorum ............................................................................................ 5

Senator Martinez .............................................................................................. 6

Senator Stabenow ............................................................................................. 13

Prepared statement ................................................................................... 35

Senator Reed ..................................................................................................... 17

WITNESSES

Alphonso Jackson, Secretary, U.S. Department of Housing and Urban Development .................................................................................................................. 8

Prepared statement .......................................................................................... 35

Response to a written question of Senator Stabenow ................................... 73

Nelda Barnett, Member, Board of Directors, AARP ............................................. 19

Prepared statement .......................................................................................... 38

Dana Olson, Executive Director, Volunteers of America’s Laurel Manor Senior

Residence, Colorado Springs, Colorado .............................................................. 21

Prepared statement .......................................................................................... 40

Stephen Proctor, President and CEO, PHI Retirement and Senior Care Services, Camp Hill, PA .............................................................................................. 23

Prepared statement .......................................................................................... 42

William T. Smith, Ph.D., Chair of the Board, American Association of Homes

and Services for the Aging (AAHSA) .................................................................. 24

Prepared statement .......................................................................................... 44

Terry Allton, Vice President of Support Services, National Church Residences 26

Prepared statement .......................................................................................... 46

Steve Protulis, Executive Director and Vice President, Elderly Housing Development and Operations Corporation (EHDOC) ................................................. 28

Prepared statement .......................................................................................... 49

David G. Wood, Director, Financial Markets and Community Investment,

U.S. Government Accountabilty Office ............................................................... 30

Prepared statement .......................................................................................... 54

ADDITIONAL MATERIAL SUPPLIED FOR THE RECORD

Various letters submitted by Senator Paul S. Sarbanes ...................................... 74

(III)

(1)

MEETING THE HOUSING

AND SERVICE NEEDS OF SENIORS

THURSDAY, JUNE 16, 2005

U.S. SENATE, COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS,

Washington, DC.

The Committee met at 10:07 a.m., in room SD–538, Dirksen Senate Office Building, Senator Richard C. Shelby (Chairman of the

Committee) presiding.

OPENING STATEMENT OF CHAIRMAN RICHARD C. SHELBY

Chairman SHELBY. The hearing will come to order.

This morning, the Committee meets to hold a hearing examining

the coordination of the housing and service needs of our Nation’s

seniors. While there are a variety of Federal housing programs either targeted to seniors, or containing special features for the elderly, few of these programs are linked with other services, such

as health care or transportation, that are vital to the well-being of

the elderly. It is all too often left up to the elderly themselves to

make the connection across the various Federal, State, and local

programs designed to assist them.

My colleague, Senator Sarbanes, has introduced legislation,

S. 705, to address this very issue. Today, over 80 percent of elderly

families own their own homes. Almost three-fourths of homeowners

own their home free and clear of any mortgage. Many seniors have

a strong desire to age in place, and I believe greater coordination

of the programs can facilitate their ability to do so.

In addition, many seniors are heavily dependent upon public

transportation in order to perform essential activities, such as

going to the supermarket or making a doctor’s appointment. However, over a third of elderly households report having no access to

public transportation. This lack of access is particularly acute in

many rural and suburban areas.

I want to note that the public transportation title of the transportation bill which is pending now in the Senate as reported out

of this Committee and passed by overwhelming support by the Senate, included significant increases, Mr. Secretary, in Elderly and

Disabled Program administered by the Federal Transit Administration.

Once again, I want to commend my colleague, Senator Sarbanes

for his leadership on this issue. I also want to recognize Senator

Santorum’s interest in this issue. We are also fortunate to have a

very distinguished group of witnesses this morning.

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Our first witness this morning will be someone who is no stranger here; the Secretary of Housing and Urban Development, Secretary Alphonso Jackson. The Committee, Mr. Secretary, greatly

appreciates your willingness to appear this morning and your attention to this very important issue.

Our second panel will consist of Ms. Nelda Barnett, Board Member, AARP, and former Director of the Maplebrook Village Christian Homes of Kentucky, where she continues to serve on as a

Board Member; Ms. Dana Jo Olson, Executive Director, Laurel

Manor Senior Residence, appearing today on behalf of the Volunteers of America; Mr. Steve Proctor, President, Presbyterian

Homes, and appearing on behalf of the Pennsylvania Non Profit

Housing Association; Dr. William T. Smith, President of the American Association of Homes and Services for the Aging; Ms. Terry

Allton, Vice President of Support Services, National Church Residences; Mr. Steve Protulis, Executive Director, Elderly Housing Development and Operations Corporation; and Mr. David G. Wood,

Director for Financial Markets and Community Investment, GAO.

I want to thank all of you for appearing here today, and we all

look forward to your testimony and having a dialogue with you.

Senator Sarbanes.

STATEMENT OF SENATOR PAUL S. SARBANES

Senator SARBANES. Thank you very much, Chairman Shelby. I

want to express my appreciation to you for holding this hearing on

S. 705, Meeting the Housing and Service Needs of Seniors Act. I

also want to recognize a group of seniors who have come to the

hearing from Marlow Heights, Maryland. We are pleased to have

them with us this morning. I want to thank all the witnesses for

the work they do every day to better the lives of American seniors,

and we look forward to hearing from them. Unfortunately, much

more needs to be done to ensure that our elderly population has

easy access to the housing and service needs they require, particularly to allow them to age in place, which is an important focus of

this legislation.

The elderly population of this country is rapidly growing, far outpacing the growth of any other age group. In 2000, the population

over 65 years of age was close to 35 million. The number is expected to grow to over 50 million by 2020, and by the year 2030,

nearly one-fifth of the U.S. population will be above the age of 65.

We obviously need to start preparing to meet the needs of this

growing population so that seniors and their families have real

choices about where and how to age. And that is exactly what the

legislation we are considering this morning will do. This legislation

is designed to address the fragmented government bureaucracy of

programs for the elderly so that seniors and their families can

more easily access needed support and remain in their homes.

We cannot put this off any longer. Each of us in the room will

be affected in one way or another. Every segment of our society is

affected. It is not just a problem of affordability, although there is

certainly an affordability problem. But the problem is lack of availability and access that is increasingly experienced by large segments of our elderly population.

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Every survey has shown that seniors overwhelmingly want to remain in their homes. They want to age in place, as they put it, or

age in noninstitutional settings. But in order to do this, we have

to better connect services to where seniors live. Over 18 percent of

senior citizens who do not reside in nursing homes have difficulty

performing their daily activities without assistance. Over 1 million

of these seniors are severely impaired, requiring assistance with

many basic tasks. Many others, those who can perform their daily

functions, still require access to health care, transportation, and

other services. And the Congressionally established Seniors Commission found in its 2000 report, ‘‘the most striking characteristic

of seniors’ housing and health care in this country is the disconnection of one field from another.’’

A recent AARP report also found this disconnect. According to

that report, ‘‘today’s subsidized rental housing is a patchwork of

disparate programs, which creates problems in coordinating housing policy for diverse needs. For instance, many properties that

serve older persons are experiencing a growing need for supportive

services as the residents’ age, but delivery of these services vary

from program to program.’’

While there are numerous Federal programs that assist seniors

and their families in meeting these needs, they are fragmented

across many government agencies with little or no coordination. We

have a diagram that illustrates this fragmentation. If this chart

looks confusing, that is because it is. That is exactly the state of

play. Housing and services are provided through different and often

unconnected programs, many with their own requirements and eligibilities.

This fragmentation has real consequences. The disconnect of

housing from services places an enormous burden on seniors and

their families in making decisions about long-term care. Families

must not only worry about the affordability of housing, but they

must also piece together health care, transportation, physical assistance, and other services. Without enhanced housing opportunities, seniors find it increasingly difficult to remain outside of nursing homes or other institutional settings. In fact, the Seniors Commission, the Congressionally mandated study that I mentioned earlier, found that, ‘‘many seniors across the income spectrum are at

a risk of institutionalization or neglect due to declining health and

the loss or absence of support and timely interventions.’’

Now, for some of the elderly, nursing homes are a necessity.

They are the appropriate choice. But for many others, options such

as assisted living, service-enriched housing, retrofitting a home,

linking services to a current home are the best way for seniors to

age, as well as the most cost-effective. Seniors and their families

should not find it easier to enter a nursing home than to remain

at home with necessary supports. When faced with difficult decisions about long-term care, seniors and their families should not

have to navigate a confusing maze of programs and services, and

work through multiple bureaucracies. We must streamline these

choices. I think an Interagency Council on Meeting the Housing

and Service Needs of Seniors will help to make options more widely

available.

4

The Council will be a high level executive office, which the Federal Government can work to consolidate and streamline the various programs that exist to help our elderly. It will be composed of

the Secretaries or designees of the agencies which operate these

various programs: HUD, HHS, DOT, Agriculture, Treasury, Labor,

Veterans Affairs, as well as the Commissioner of the Social Security Administration, the Administrator of the Centers for Medicare

and Medicaid Services, and the Administrator of the Administration on Aging. It will review all Federal programs designed to assist seniors, identify gaps in services, recommend on how to reduce

duplication, identify best practices, and work to improve the availability of housing linked with services. The Council will be charged

with monitoring, evaluating, and recommending improvements in

existing programs and services to make sure that the Federal Government in concert with States, localities, and private sector partners, is doing all they can to help seniors age in place or find alternative, suitable living arrangements.

Mr. Chairman, I think this legislation could be an important first

step. This is an effort to get a process working by which we can

enhance the services, coordinate them, remove duplication, fill in

the gaps, put some focus on what I think is a pressing problem now

and will, obviously, increasingly become a pressing problem.I look

forward to hearing from Secretary Jackson. We are pleased to have

him back before the Committee and the panel to follow.

Mr. Chairman, I have a number of letters here from various organizations: The AARP, which, of course, we have had a lot of dealings with; the Elderly Housing Development Operations Corporation; the Elderly Housing Coalition, made up of a number of

groups; the American Association of Homes and Services for the

Aging; American Association of Service Coordinators; the National

PACE Association; National Housing Conference; United Jewish

Communities; the Housing Assistance Council; NARO, which, of

course, has been before our Committee on a number of occasions;

the Council of Large Public Housing Agencies; the National Affordable Housing Management Association; the Enterprise Foundation;

and the National Leased Housing Association; and the National

Low Income Housing Coalition, and I ask that all of these letters

in support of this legislation be included in the record.

Chairman SHELBY. Without objection, it is so ordered

Chairman SHELBY. Senator Allard.

STATEMENT OF SENATOR WAYNE ALLARD

Senator ALLARD. I would like to thank you, Mr. Chairman, for

holding this hearing. Nearly all of us have to address the needs of

aging parents or aging grandparents or other family members, so

we understand the challenges present to today’s seniors, and I appreciate this opportunity to more closely examine one way to help

meet those challenges.

I would also like to commend Senator Sarbanes for introducing

S. 705, ‘‘Meeting the Housing and Service Needs of Seniors Act of

2005.’’ He and I worked together previously on creation of the Congressionally chartered Seniors Commission, and this bill will help

implement their recommendations to promote better coordination.

5

Quite simply, coordination makes sense. It makes sense for the

Government, taxpayers, and it makes sense for the people served

by the programs. Utilizing a similar model, we have seen improvements to the programs and services for homeless individuals under

the Interagency Council on Homelessness. I am hopeful that we

can find similar benefits under the Seniors Commission. As the

baby boomers age, it is increasingly important that we ensure that

they have the information necessary to make the most appropriate

decisions regarding housing, services, and other needs.

I firmly believe that seniors want to live in their own homes. I

think that our challenge is to do whatever we can to help facilitate

their desire to live in their homes. That means making home care

services more available; it means making it possible for them to

stay in their homes. I think in this age of high technology that we

certainly have an opportunity, perhaps, to even extend long range

type medical services into the home. You connect it in for an EKG

on the chest, for example, or they can plug in periodically to perhaps have an evaluation. And I think there are other opportunities

to get a high tech solution into homes that will facilitate those senior and elderly parents and grandparents and other family members to stay in that home with a minimum of support from family

members.

At one time, family members were always present, but now, they

are not. They are spread all over the United States, and it is not

always convenient for that level of care to happen. So, I think that

Senator Sarbanes is addressing a real issue that we have here in

our society, and I commend him for that. And in particular, I support S. 705 to identify and help eliminate inefficiency and duplication. This will ensure that all taxpayer dollars invested in housing

and services for seniors are maximized.

I would like to also welcome today’s witnesses to the hearing.

Your perspectives will be important as we consider this bill, and

you bring first hand knowledge of the importance of giving seniors

the option to age in place. I would like to extend a special welcome

to Dana Olson, who is testifying on behalf of Volunteers of America. Dana is from Colorado Springs and does excellent work at the

Laurel Manor Senior Residence to assist seniors. Dana, I am glad

that you are here.

I also look forward to your testimony, Mr. Secretary, and I know

that you bring a special perspective also. And I look forward to

working st Senator Shelby, Senator Sarbanes, and Senator

Santorum. Now, we have a run of Ses there, do we not?

Chairman SHELBY. We do.

[Laughter.]

Senator ALLARD. To move this bill forward to help meet the housing and service needs of our Nation’s seniors.

Thank you, Mr. Chairman.

Chairman SHELBY. Thank you.

Senator Santorum.

STATEMENT OF SENATOR RICK SANTORUM

Senator SANTORUM. Thank you, Mr. Chairman, and thank you

very much for holding this hearing, and I appreciate the work that

you have done; Senator Allard, I appreciate the work that you have

6

done; and in particular, I appreciate the work, obviously, of Senator

Sarbanes, who introduced Senate Bill 705, and I am honored to be

a cosponsor of that legislation. And I do not want to reiterate what

everyone said. Everyone has covered the legislation and certainly

the reasons for it, and I share with everybody the importance of

this issue.

We have a very large senior population in Pennsylvania. The average in the country is about 12 percent of our population is seniors. We have a third more. We have a 16 percent population of

seniors in Pennsylvania. We are second to the State represented by

the gentleman on my left in the percentage of seniors in our population, but I believe his number is going down, and our number is

going up.

It is a big concern for us in Pennsylvania, and we can continue

to build senior housing facilities and all sorts of other things to do

really what this legislation and this hearing is intended to do,

which is instead of building new facilities, to try to integrate these

services to try to provide them at home so people can age in place,

as Senator Sarbanes said.

And that, to me, is the ideal. That is the one that I think most

seniors would like to have happen. I know it is one that my people

are going through at this time, and my in-laws are going through

at this time in their lives. So it is very personal, and it is very important to the people in my State, and I appreciate the attention

that the Committee is directing at it, and I look forward to working

together on a bipartisan basis to make some progress in this area.

Thank you very much, Mr. Chairman.

Chairman SHELBY. Thank you.

Senator SANTORUM. And I apologize; I have to leave. We have a

markup in the Finance Committee on the energy tax title, so if you

will excuse me——

Chairman SHELBY. That is important, too.

Senator SANTORUM. Thank you, Mr. Chairman.

Chairman SHELBY. Senator Martinez. You know, it is not often

that we get the former Secretary of HUD together with the current

Secretary of HUD.

[Laughter.]

Chairman SHELBY. Senator Martinez.

STATEMENT OF SENATOR MEL MARTINEZ

Senator MARTINEZ. Thank you, Mr. Chairman.

I am very proud to be here today for this hearing and with my

colleague and former partner at HUD. But Senator Shelby and

Senator Sarbanes, I appreciate your holding this hearing on this

important subject, and Senator Sarbanes, I commend you for taking the initiative to identify the growing needs of our elderly population, and I am very supportive of Senate Bill 705, which would

create an interagency council to oversee the housing and service

needs of the seniors.

But I am also pleased to welcome here today my good friend Secretary Jackson. I also want to make a special note: Today is the

first time that I have had occasion to see our new Assistant Secretary for Housing and Housing Commissioner, Brian Montgomery,

a good friend and a wonderful person who I know is going to do

7

a great job in this very important position, and Mr. Secretary, first

time I can call you that; wish you all the best, and I hope you will

call if I can be of any help to you in your new responsibilities.

But I have an additional special pleasure today, Mr. Chairman,

which is also to introduce one of today’s witnesses to the Committee. It is Mr. Steve Protulis. He is here from Fort Lauderdale,

testifying on behalf of the Elderly Housing Development and Operations Corporation, where he serves as the Executive Director and

Executive Vice President.

His agency is considered the premier provider of quality, affordable housing for seniors in the United States. It manages 42 properties in 14 States, offering affordable living options for low-income

seniors. Mr. Protulis was formerly the Assistant to the President

of the AFL–CIO and Executive Director of the National Council of

Senior Citizens, one of the Nation’s strongest voices for older Americans and families. He also served on the U.S. Commission on Affordable Housing and Health Facility Needs for Seniors in the

Twenty-First Century, a committee appointed by the U.S. Congress.

The Elderly Housing Development and Operations Corporation is

dedicated to promoting quality, affordable housing for seniors. It is

committed to the principle of aging in place, ensuring opportunities

for elderly citizens to live independently with dignity and self-determination with their peers. The State of Florida is home to more

than 2.8 million residents over the age of 65, and while my distinguished colleague from Pennsylvania was right in terms of percentage of population the fact is that it is a growing population.

Over the next two decades, more than 3.6 million Floridians will

reach retirement age. According to the 2000 Census, 51.2 percent

of Floridians over the age of 65 are considered low income, and

43.8 percent are considered very low income. As health care and

housing costs continue to rise, and in Florida, housing costs rise

dramatically each and every day, Florida residents will grow increasingly dependent upon the types of services Mr. Protulis and

others like him are providing.

In Miami-Dade County alone, the Elderly Housing Development

and Operations Corporation manages five low-income housing

projects, which currently serve 750 residents with more than 1,300

eligible residents on waiting lists. In addition to offering basic

health services such as blood pressure screening, and dental hygiene, the corporation contributes to the overall wellness through

its prescription monitoring programs and educational classes on

nutrition, exercise, and computer training.

I thank Mr. Protulis for being here today and look forward to his

testimony. But I want, in further evidence of Senator Sarbanes’

proposal and the things that he has been speaking of; you are talking about 1,300 eligible residents of Florida on the waiting list just

for these facilities in Dade County alone. That just goes to show,

Mr. Chairman, what a tremendous need there is in this area for

more avenues of coordination and more opportunities for seniors to

be provided decent, safe, and affordable housing.

Thank you, Mr. Chairman, and I look forward to the testimony.

Chairman SHELBY. Thank you, Senator Martinez.

8

Secretary Jackson, your written statement will be made part of

the hearing record in its entirety. You proceed as you wish. Welcome again.

STATEMENT OF ALPHONSO JACKSON, SECRETARY

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT

Secretary JACKSON. Thank you very much, Chairman Shelby,

Ranking Member Sarbanes and distinguished Members of this

Committee. Thank you for inviting the Department to testify on

the Meeting the Housing and Service Needs Act of 2005. I commend Senator Sarbanes for bringing this matter to the attention of

the Committee. Mr. Chairman, in order to reserve as much time as

possible for questions, I will ask that I be allowed to summarize

the statement.

This Administration is strongly committed to meeting the needs

of America’s senior citizens. That commitment will be very publicly

displayed this afternoon when President Bush visits the Department of Health and Human Services to roll out the Nation’s Medicare prescription drug benefit for seniors.

The senior population, those aged 65 and over, continues to grow.

In the last decade, the elderly population has increased by 10 percent, and this trend is certain to accelerate. Over the next 5 years,

the children of the World War II generation will turn 65, followed

by the baby boom generations, which I am a member of. Within

that horizon, we have every reason to believe that the number of

seniors will double by 2030. By then, the Census Bureau estimates

that 20 percent of Americans will be older than the retirement age.

As the senior population grows, so do challenges we face in meeting seniors’ housing needs. First, we must find ways to maximize

housing resources in order to serve a growing number of seniors.

Second, we must provide for very low-income seniors while allowing

for aging in place. Third, we must improve the data collection

methods and improve dissemination of that information to the end

user. Fourth, we must better coordinate all Federal levels, working

agencies to provide the seniors the best service. And fifth, we must

create a better linkage between needed assessments, evaluation,

and research.

Clearly, this Nation will need to address the senior housing

issues from a different perspective than we have in the past. As the

Committee knows, HUD has a long history of providing housing,

delivering related services to the Nation’s low and very low-income

elderly. Specifically, Section 202 programs provide important resources to address the housing needs of the elderly. More than

375,000 units have been funded since the inception of the 202 program, which was established in 1959. More than 6,000 new units

have been funded under the Section 202 program annually.

These housing programs are sponsored by nonprofit organizations. Many of them are faith-based. These organizations have a

history of serving the elderly and are committed to meeting the

needs of a very vulnerable population in our society. The Administration is dedicated to the ongoing viability of the Section 202 program. We are committed to working with Congress, with nonprofit

organizations that sponsor these important projects, and with the

elderly persons who are eligible to reside within them.

9

HUD’s commitment to the Section 202 program goes beyond

building housing for the elderly. We also want to ensure that the

seniors have the services they need in order to live comfortably.

Seniors tell us they want to live independently as long as possible.

The Administration has recognized the importance of addressing

both the housing and servicing needs of the elderly and has made

these issues a top priority.

The Department agrees with the Committee that seniors require

a wide array of housing options with access to services, including

meals, transportation, health care, and other assistance. We also

agree that there are numerous Federal programs that assist seniors and their families in meeting these needs. Many government

agencies exist at the State and local level, but we need coordination. The Department has made an effort to coordinate to the

greatest extent possible with other agencies in its program, but

there can always be improvement in communications, coordination

to ensure that seniors have access to decent, safe, and sanitary

housing and can obtain the necessary supportive services.

As I understand it, the legislation before this Committee proposes an interagency council to promote a more cost-effective Federal response to meeting the needs of housing for the seniors. If we

are able to inspire an effective cooperation among the Federal

agencies that address housing needs of seniors, the effort will yield

long-term savings that could pay for home-based amenities.

We believe the legislation before you today is a good idea. The

concept creates the Interagency Coordinating Council for the Federal Government. This is very important for the uniqueness of the

operation. There are some technical aspects that the Administration would like to work with Congress to address. In closing, let me

say that the Administration and the Department are committed to

working with Congress and the industry partners to address the

growing needs of affordable elderly housing and the necessary supported services. This proposed legislation will provide the opportunity for us to work with government agencies and stakeholders

and coordinate more effectively a basis for requiring us to address

these needs.

And in closing, which is not part of my testimony, I would just

like to say that again, I would like to commend Senator Sarbanes

and this Committee. I was in a very unique position in the sense

that I had a very great debate with my brothers and sisters, as

Senator Martinez knows, about my mother, and I made the decision that my mother would not go into a home. It was very difficult

financially for me, but my mother lived in her home until her

death, because I thought it was important for her to have that comfort, and so, I am very much committed to working with you on

this specific issue.

Chairman SHELBY. Thank you, Mr. Secretary.

You have had a lot of experiences, Mr. Secretary, dealing with

various agencies here, and it is difficult at times to get different

agencies to work toward the same objective, even when they share

the same goal.

Secretary JACKSON. Right.

Chairman SHELBY. One attempt at this in which you have been

involved is the Interagency Council on Homelessness. Could you

10

share briefly with the Committee how well you believe that council

has worked and whether that experience for you can offer us any

lessons in designing S. 705?

Secretary JACKSON. Yes, Mr. Chairman. I will say this: As you

know, Senator Martinez at that time was Secretary Martinez, who

was the first chair, and I worked with him closely. I think that

President Bush has insisted and continues to insist that the agencies work together. What has occurred before President Bush is

that we had very simple domains where people did not want to

interact with one another. The Interagency Council on Homelessness has made great strides, because we have talked with each

other. We have come together to make sure that the needs of the

homeless are addressed from a holistic perspective, not from a

piecemeal perspective.

I think the same thing can occur here with this legislation, because it forces us to talk and address the needs of the seniors not

again in a piecemeal fashion.

Chairman SHELBY. Sure.

Secretary JACKSON. But in a very whole fashion.

Chairman SHELBY. Mr. Secretary, under the terms of S. 705, the

Council would be chaired on an alternating annual basis between

the HUD Secretary, in your case now, you, and the HHS Secretary.

Do you believe that one year is enough time for a chairman to be

effective, or should we consider expanding this to a longer term?

And in addition, should we be limiting the chairman to just the

HUD and HHS Secretaries? I realize they are high profile cabinet

members.

Secretary JACKSON. Sure.

Chairman SHELBY. Or should other Council members also be eligible to serve as the chair? I do not know. I can see the point of

both Secretaries, because you are the Secretaries.

Secretary JACKSON. Right.

Chairman SHELBY. You are Cabinet members, and that lends a

lot of not only power but also prestige to what you are doing.

Secretary JACKSON. I would say, Mr. Chairman, I do not disagree

with the chairmanship rotating between Housing and Human Services, because I think we have a direct effect on the lives of many

seniors in this country.

Chairman SHELBY. You do.

Secretary JACKSON. There are some ancillary effects that the others have. So if we are going to try to do the very best we can to

give the best service, I think those who are directly related on a

day-to-day basis will be the best persons to chair.

Second, I believe, having served on a number of boards, a number of university boards, that a two-year rotation is usually the

best, because you are able at that point in time to get many of the

programs started. And then, there is a continuity of about 6

months between you and the next chairman to discuss and make

sure.

Chairman SHELBY. But you are still on the board, even though

you rotate, right?

Secretary JACKSON. Yes, yes, you are still on the board, but I

think that a one year service is fine, but I just think you have better coordination and continuity if you have a 2 year period.

11

Chairman SHELBY. Senator Sarbanes.

Senator SARBANES. Thank you very much, Mr. Chairman.

First of all, Secretary Jackson, could we assume that if this legislation becomes law, this allows for the Secretary or a designee of

the Secretary, and I am interested in how much you would expect

to be personally involved yourself in providing leadership to the

council as opposed to turning the responsibilities over to a designee. Now, I know you are a busy man. The Secretary has a range

of responsibilities. On the other hand, I do think to get this moving, certainly, and to get it up and going with the kind of authority

behind it that I think it requires, we need the top people to take

interest and not immediately turn it over to a designee, and I am

just looking for some assurances out of you, at least, with respect

to that issue.

Secretary JACKSON. Not only will I assure you, but I will also

promise you that I will give this my utmost attention. I am extremely fond of seniors. I have always made sure that seniors live

well. I am committed, and I have to tell you in many ways it did

not come to my mind, but I am elated by this legislation, because

I think it is going to do a very important job for seniors in this

country, where we have not done it before.

Senator SARBANES. We have been in the process of converting

some of the 202 senior housing into assisted living type facilities.

I know HUD has taken an interest in doing that. I wonder how

much cooperation you are getting from other Departments and

Agencies in achieving that and particularly from HHS, which, of

course, as you just pointed out, is the other Department that has

a range of programs that are highly relevant to what we are concerned about here.

Secretary JACKSON. We have had good coordination, but I think

with this legislation, if it passes, it will force us to have much better coordination than we have had before. But I cannot say that it

has been a negative effect on us. It has been very, very supportive.

Senator SARBANES. One of the things the Council might do in the

process of coordination is really develop a master strategy for coordination and implementation of these provisions, so there is actually a framework set up to accomplish this rather than it being

done more on an ad hoc basis as we move along from month to

month.

And that has been one of the things we are seeking to do. It

would seem to me that the Interagency Council, we set up the

Trade Promotion Coordination Committee, and out of that, they

now develop a trade promotion coordinating strategy every year.

They keep updating it. They bring all the agencies and departments together to try to have a concerted strategy, and it seems

to me we need to do something similar with respect to the housing

and service needs of seniors.

Secretary JACKSON. I think, Senator Sarbanes, that the more

structured it is, the better it is, because I think we can then focus

in on addressing the needs of seniors from a very whole perspective. I do not like that term holistic but from a very whole perspective. And as I said at the end of my speech, one of the problems

that I faced with my mother was that her needs were many, and

you were at one specific agency to another agency trying to get

12

those needs addressed. I think if we can structure it, the better off

we are.

Senator SARBANES. Thank you very much, Mr. Secretary.

Thank you very much, Mr. Chairman.

Chairman SHELBY. Senator Allard.

Senator ALLARD. Yes, Mr. Secretary. You have to find a home for

this commission. Are you comfortable having it in HUD? I would

assume that you are.

Secretary JACKSON. Senator, Mr. Chairman, and Ranking Member, if you are comfortable, I am comfortable.

[Laughter.]

Senator ALLARD. Do you feel that you could adequately serve the

needs of this commission in your agency?

Secretary JACKSON. Yes, I do, and if you choose to put it there,

let me say this to you: I cannot reiterate again; Senator Martinez

is here. I was very committed to my mother staying in her house,

and I am very committed to elderly. And I will do whatever. As I

just said to Senator Sarbanes, I will specifically take great pleasure

in making sure this works if that is your desire.

Senator ALLARD. Now, I notice that we have a number of reports

being called on from the various agencies. I am assuming with this

commission, all these various agencies also submit reports for the

Government Procedures and Results Act. Are we duplicating it?

Does the Government Procedures and Results Act already have

enough reporting there that all you have to do is make sure a copy

of that gets to maybe a different set of people? Or do we need a

whole different set of reports?

Secretary JACKSON. That is a difficult question to answer. I think

we do an awful lot of reporting, and I think if we can streamline

it, it is all for the best. But in the process of streamlining, I think

there still must be accountability.

Senator ALLARD. Well, that is the reason I pulled up the Government Procedures and Results Act.

Secretary JACKSON. Right.

Senator ALLARD. Because the whole idea of that is to have accountability. You measure performance. You put out specific goals

and objectives, and then, you do it in a measurable way.

Secretary JACKSON. Sure.

Senator ALLARD. And so that whoever is overseeing these programs, including the Congress, gets a feel of whether they are

meeting certain parameters and what not.

Secretary JACKSON. I think that is very important, and let me

say this: That is what President Bush has done with the President’s Management Agenda. There has been a number of hue and

cries about us having to report and live up to it, but I think it has

been the catalyst to make us more effective in managing. And that

is why I said if we can streamline the accountability, yes, I think

it is important to have it. Otherwise, there is no measurement tool.

Senator ALLARD. I want to also just bring up this issue of how

do you plan on cooperating with State and local agencies? There

are a lot of them involved, and I think a lot of States have taken

a different perspective here, and is there a way that we can facilitate the State and local involvement and not get too meddlesome?

13

Maybe you could comment on that and how we could evaluate in

a way or put together a program that takes those concerns.

Secretary JACKSON. Since this is such a universal problem that

we are all going to face, and there is no question that we will all

face it quicker than we think, I think the more persuasion of all

members of this interagency committee, whether it be HUD,

whether it be Health and Human Services, Labor, will use our

moral persuasion to discuss this issue with governors, with county

administrators, with mayors to show them how important it is that

we address this need from a whole perspective. And from my interaction with both governors, county administrators, mayors, it has

not been a very difficult process to get them to understand vital

issues that are necessary to be addressed in their respective jurisdictions.

Senator ALLARD. Thank you, Mr. Chairman.

Chairman SHELBY. Senator Stabenow.

STATEMENT OF SENATOR DEBBIE STABENOW

Senator STABENOW. Thank you, Mr. Chairman, and first, I would

ask that my opening statement included in the record.

Chairman SHELBY. Without objection, it is so ordered.

Thank you for calling this hearing, and thank you to Senator

Sarbanes for your leadership on this very important issue, and Secretary Jackson, it is nice to see you again. Welcome.

Secretary JACKSON. Thank you so much.

Senator STABENOW. I do have a specific question, but I did want

to make a couple of comments first. And that is that I think we

all come together in support of certainly seniors, our parents, older

adults, but there are a lot of big things in front of us right now

that will determine whether or not we put those words into actions.

I am a believer that it is about action, and just a more general

statement for my colleagues, I mean, we look at the fact that over

60 percent of older Americans rely primarily on Social Security to

live, the debate about privatizing part of Social Security is a big

deal; it is a big part of this, and I am greatly concerned about that;

Medicare and what we are doing there has a huge impact.

This Congress just passed a $10 billion cut in Medicaid, which

is my State, the majority of those are low-income seniors in nursing

homes. What is a $10 billion cut going to mean for them? We are

hearing States debate optional services, and when we go down the

list of optional services for low-income health care, it is things like

being able to see—eyeglasses—being able to hear—hearing aids—

being able to chew your food—dentures. Certainly, I do not consider that optional for me, in my family, and so I just raise that.

That is certainly beyond what we are talking about today, but it

is a lot of very serious things affecting older adults today and decisions that are being made, including things like home health care

and whether or not we are going to see a long scheduled cut actually happen in home health care.

I just want to bring to your attention, this is not something directly for you, but there are some simple things we can do as well

for older adults: The Commodities Supplemental Food Program

right now does not allow seniors to deduct their medicine in order

to qualify for supplemental food payments. Some of us have been

14

trying to change that for some time, and it seems to me that we

could come together and help change that so that medicine does

not count when meeting low-income standards, because for low income seniors in the commodities programs, they are literally choosing between food and medicine right now. So there are a number

of things we can do.

But on to my question: You and I had an opportunity to speak

before you were confirmed, and I supported your confirmation,

about the growing number of grandparents that are raising their

grandchildren, and in fact, we were successful, and I appreciate the

support of Members of the Committee and the Senate, we were successful in the American Dream Act of 2003 in adding a provision

to create demonstration projects, from two to four demonstration

projects in Section 202 housing for grandparents raising grandchildren, to be able to allow both accommodations in terms of play

equipment and other things, to be able to look at the impact in Section 202 housing.

And there were two other provisions. One was a HUD Census

study to be done as it relates to Section 202 housing, and the other

was that this instructed how to train employees in the rights of

grandparents raising grandchildren. I would like to know the status on that provision.

Secretary JACKSON. I cannot tell you details today, but I will get

back to you specifically with the details. I know that we have set

it up, but I have to be very honest with you: I am not prepared

to tell you the end results today, but I would be happy to get it

to you immediately.

Senator STABENOW. I would appreciate that. This is a provision

supported by the House, Senate, and the White House. It is in law.

We have a lot of older adults now taking on the responsibilities,

again, of being parents, and we want to make sure that they are

not inadvertently discriminated against in their housing needs.

And I think it is very important that we move forward in implementing those provisions.

Secretary JACKSON. I know we have started. I just want to give

you the best details now, and I cannot do that right now, but I will

get it to you immediately.

Senator STABENOW. Thank you.

Thank you, Mr. Chairman.

Chairman SHELBY. Thank you. Senator Martinez.

Senator MARTINEZ. Thank you, Mr. Chairman.

Secretary Jackson, a couple of questions on this issue. I know

that the Interagency Council on Homelessness really, when we revitalized it, worked I think extremely well, and I hope it continues

to be a help to the homeless population like we hope this will be

to the elderly population. I wondered if one of the things that had

occurred is it had just fallen off and even though still statutorily

authorized, it was not happening. And we took up the mantle and

have revitalized it, and it is off and going again. I guess what I

would want to make sure, Mr. Chairman, in the course of this legislation is we do not let that happen. If we put it in the books, we

want it to be something that has to be accountable enough to

where it continues to happen.

15

I also believe that Senator Sarbanes asked a very pertinent question, which is about your participation. I am delighted with your

commitment. I know it will be there, but I also believe, Mr. Chairman, one of the essential keys to the success of the Interagency

Task Force on Homelessness was not only was I participating and

vitally interested but that it also made the commitment of the Secretary of HHS at the time to also be involved. Secretary Thompson

and I worked together, and the fact that we would both show up

at meetings, and we both delivered on the agenda that was set for

the meetings made it happen.

I am concerned about the designee portion of this, and I know

that I, of all people, should understand how busy Cabinet secretaries are, and I know that for many of these secretaries, it is going

to be impossible for them to attend: The Secretary of Treasury, for

instance, a designee would be fine. But I think as to the Secretaries

of HHS and HUD, particularly if they are going to be chairing the

commission, that their commitment and their personal involvement

is going to be vital to the success of it. And I would want to find

some vehicle by which we could ensure that that took place.

Do you not think, Mr. Secretary, that that part of the commitment has to be there, at least in those two key departments, to

make sure that it works? Because if it gets designated down the

road, sometimes, the bureaucracy does not get the message if the

designee is too far down the road.

Secretary JACKSON. I agree with you, Senator, I agree. And that

is why when Senator Sarbanes asked me if I would personally commit as long as I am Secretary to being involved, I said yes. Because

this, to me, is a very critical issue that we are going to face.

Senator MARTINEZ. And I think also a two-year chairmanship

would probably add to that same continuity of getting it done. But

one other thing that was very successful in the Homelessness Task

Force was the fact that we had a local tie-in as part of our strategy;

in other words, the Interagency Council came together, but then,

the work of the Interagency Council with our strategy then being

picked up by mayors throughout the country really has given it life.

It is not only what we are doing here in Washington but also

what is happening in Dallas, Orlando, Miami, wherever it may be

around the country. And I believe that part of the charge should

be that we somehow develop a strategy of how local governments

can also participate in an interagency or intercouncil task force to

make sure that the work that is being done here federally has a

counterpart at the local level, where the rubber meets the road,

really.

Secretary JACKSON. Right.

Senator MARTINEZ. And so, I would think that maybe not formally in the statute but certainly as part of the charge that some

local tie to the deliverers of local services in local government, that

they be also, through our grant programs or however, that they

might also be encouraged and directed to cooperate, because the

same divisions and the same fragmentation that happens here also

happens at the local level.

Secretary JACKSON. I think two things, Senator. First of all, I

think that if it is passed, the first thing we must do is meet frequently for the first 2 to 3 years to establish the importance of the

16

Commission and what its objectives and goals are. Second, I think

within those first 2 or 3 years, from my perspective, it would be

well to go out two to three times a year into the respective States

or communities to let them have a voice in the say of this Commission and how they think it affects their States.

I felt, when I was Deputy Secretary under Secretary Martinez,

that having the executive management meetings in the field within

our 10 regional offices was one of the most effective things that occurred, because he and I learned an awful lot about HUD that

most secretaries never knew. Because once we were there in the

field, they gave us great advice of how they felt we were not running very well, and we were able to benefit from that.

I think the same thing could be said for how we address the

needs of seniors. Because the needs of seniors in Florida are quite

different from the needs of the seniors in Alabama, because we

know that a number of the seniors in Florida have worked most of

their lives, and they do not need Social Security as well as some

of the seniors in Florida or in Texas. So if we listen to the States,

I think we will be better equipped to address the issues.

Senator MARTINEZ. One last issue, Mr. Secretary, is the issue of

reverse mortgages, and I know you probably would not be prepared

to answer that for me today. But the question I have, and perhaps

our newly minted and capable Housing Commissioner can help us

with this. The issue of reverse mortgages is a vehicle by which seniors can obtain equity out of their homes to allow them to defray

other expenses, whether it might be property taxes, whether it

might be just living expenses, home improvements, whatever.

I know there is a desire to see the FHA current cap be removed

so that there is no ceiling on the number of reverse mortgages that

can take place. I am also very interested in the fact that it has a

requirement for financial counseling prior to any of these mortgages taking place.

Secretary JACKSON. That is right.

Senator MARTINEZ. I would just like to know from FHA what the

experience has been. What has been the track record in terms of

the impact on elderly homeowners who engage in this practice and

I know that there are many good stories of how to solve problems

for them; the infusion of equity cash can be a tremendous opportunity to get this equity that is latent there but get this capital to

use in their later years.

Secretary JACKSON. Sure.

Senator MARTINEZ. And the issue of the cap and whether it

should be removed or not. Another issue I know that is of concern

that industry is the issue of the local FHA limits and whether they

operate unfairly in neighboring communities just by the mere fact

of geography and not home prices. So, I would appreciate an update from Mr. Montgomery, who I am sure has a his hands full

with a whole lot of other things, on this whole issue of reverse

mortgages and where we should go with it in terms of future caps

or no caps, and just a good experience on where we have been and

where we should go.

Secretary JACKSON. I can assure you that Assistant Secretary

Montgomery will get on that immediately.

[Laughter.]

17

Senator MARTINEZ. Yes. It would be a good chance to see him.

And thank you very much, sir.

Chairman SHELBY. Senator Reed.

STATEMENT OF SENATOR JACK REED

Senator REED. Thank you very much, Mr. Chairman.

I certainly want to commend Senator Sarbanes for this legislative proposal. It makes great sense, and in one very real sense, it

is overdue. I mean, we recognize we have to coordinate better. And

Mr. Secretary, thank you for your testimony and your service.

One of the aspects of the seniors who want to stay in place is

that to stay in place, they need more assistive services. I know we

have the 202 Senior Housing program. There has been some effort

to try to incorporate more services so it becomes more of an assisted living arrangement rather than simply a rental unit. Can

you comment on what you and HHS and others are doing to try

to help this transformation?

Secretary JACKSON. I think as the Chairman said, at one time,

we were basically somewhat obstinate about getting into the assisted living area. We realize today more and more, that is needed;

that many of the people can live, but some of them cannot live directly independent of each other. And that is why I said to you that

Health and Human Services and us have been working well. But

if we have a structure in place that says this is the best way to

address it, I think it will be much better.

And I, in reading the legislation Senator Sarbanes has proposed

to us, I think that that begins to give us a structure, and we will

be, in essence, forced to work much closer than we have in the

past. And that is not to say that it has been negative. it has been

very positive. I will tell you that.

Senator REED. I appreciate that, Mr. Secretary, and we all recognize that this is a growing demand, that this is a growth industry

for seniors. I point out in my notes that by the year 2030, nearly

one-fifth of the U.S. population will be over 65.

Secretary JACKSON. That is correct.

Senator REED. I will be 85, with any luck.

[Laughter.]

I take some solace in knowing that Rhode Island is the fifth-largest State with a population over 85 years old, so I have lots of company back home. But we are addressing these issues of increased

growth and demand with relatively flat budgets. The 202 budget

has been declining slightly; in fact, doing reasonably well given the

huge pressure on the budget, but if this was a situation of a constant demand, we would feel pretty good about it.

And essentially, at the heart of the interagency effort are efforts

by HHS to give support, which is typically Medicaid; as you understand there is a $10 billion cut hanging out there in Medicaid funding. And I would also point to transit funding, which is also so critical to seniors so that they can maintain their independence.

Secretary JACKSON. True.

Senator REED. Particularly the innovative programs, the small

jitneys that move around and take people to programs and not traditional bus service.

18

So my sense is your great challenge would not be just talking to

each other but finding the resources to meet this effort. Any ideas

that you have in that regard?

Secretary JACKSON. It is always a challenge for the resources.

There is no question, Senator Reed. But I do believe this, that if

we are able to put in place the legislation that we proposed for the

flexible voucher program, we will level off the Section 8 program,

which will help us tremendously look at other programs that I feel

are very critical to the needs of HUD and the elderly, the handicapped, and others.

And I think that once we do that, stop the growth of the program

as exponentially as it has been, I think we can address many of

the issues you just said.

Senator REED. Well, Mr. Secretary, I hope we do not just get in

a situation of shifting the burden to another population. One of the

reasons, I think, for the growth in the Section 8 subsidies is because the housing market has been accelerating dramatically.

Those costs go up. And if you want to compensate a private landlord for putting people in his unit, you have to give him a subsidy

that is at least remotely related to what he could get by going out

in the market and putting people in.

Secretary JACKSON. I agree with you, but let me say this to you,

because we are talking about regional areas. If you are talking

about the East Coast or the West Coast, yes, that is the case. But

if you are talking about the Southwest, the Midwest, the Southeast, the affordable housing rates in many of the markets have

gone down substantially. And I think clearly, we understand that,

and we compensate for the East and West Coasts.

Senator REED. I am particularly interested in compensating for

the East and West Coasts. The East Coast.

[Laughter.]

The West Coast has their own people here, but from my perception, you can find Mr. Secretary, areas where the housing is rather

stable, and the prices have been reasonable, but I have seen up in,

the Minneapolis area, where it is very expensive there, and that is

smack dab in the middle of the country, so I do not think it is entirely the East Coast.

And as you know, there are some of us who are trying to do some

things with affordable housing in this GSE bill, and we will get a

chance to talk about that later.

Secretary JACKSON. All right.

Senator REED. Thank you, Mr. Secretary.

Secretary JACKSON. Thank you.

Chairman SHELBY. Mr. Secretary, we thank you for your appearance, and I know you will be back. Thank you very much.

Senator SARBANES. Could I ask the Secretary a question before

he leaves?

Chairman SHELBY. Sure.

Senator SARBANES. Are you all keeping an eye on this marked

increase in interest-free mortgages where they pay only interest

and are not paying down the principal at all?

Secretary JACKSON. Yes, we are.

19

Senator SARBANES. All right; because I think the potential implications of that could be very far reaching if the economy takes

something of a dip.

Secretary JACKSON. I think you are absolutely correct. And we

are very much so, and I have had a number of discussions with

Secretary Snow. That is a very critical issue.

Chairman SHELBY. Thank you, Mr. Secretary.

Secretary JACKSON. Thank you.

Chairman SHELBY. Our second panel will be Ms. Nelda Barnett,

Board Member, AARP. Senator Bunning wanted to introduce Ms.

Barnett, and he has a statement for the record. He is in a markup

now, and he cannot be there, in another Committee, but I want to

put his statement on his behalf into the record.

Ms. Dana Jo Olson, Executive Director, Laurel Manor Senior

Residence; Mr. Steve Proctor, President and CEO, Presbyterian

Homes, Inc., Pennsylvania Nonprofit Housing Association; Dr. William T. Smith, President, American Association of Homes and Services for the Aging; Ms. Terry Allton, Vice President for Support

Services, National Church Residences; Mr. Steve Protulis, Executive Director, Elderly Housing Development and Operations Corporation; Mr. David G. Wood, Director, Financial Markets and

Community Investment, U.S. Government Accountability Office.

I have introduced you earlier, but I wanted to do it again for the

panel. Thank you very much. All of your written testimony will be

made part of the record. We are probably going to have a vote on

the floor and have to cut loose but not yet, and we will start with

you, Ms. Barnett, if you will sum up your testimony in 5 minutes

or less.

Ms. BARNETT. I will do the best I can.

Chairman SHELBY. Thank you so much. Welcome all of you.

Ms. BARNETT. Thank you very much. Thank you and welcome for

your note on Senator Bunning. His staff had contacted me.

Chairman SHELBY. Yes. Senator Bunning is a very important

Member of this Committee. He is on the Finance Committee, and

he is tied up, and he better be where he is right at the moment.

Ms. BARNETT. Thank you very much.

Chairman SHELBY. But he did want me to mention that.

STATEMENT OF NELDA BARNETT

MEMBER, BOARD OF DIRECTORS, AARP

Ms. BARNETT. I appreciate it. And I thank you for this opportunity to testify this morning. I am Nelda Barnett and I am from

Owensboro, Kentucky. I am also a Member of AARP’s Board of

Directors.

My remarks this morning will focus on the need to improve coordination among the various agencies, levels of government, and

providers of housing and related supportive services that older

Americans require in order to age with dignity in our own homes.

It goes without saying that housing is a critical factor in determining our quality of life.

During the 1990’s, Americans on the average improved the quality of their housing, but despite the progress of the 1990’s, many

low-income and moderate income, older Americans continue to experience serious housing problems, and their numbers are growing.

20

Already, what we call the ‘‘old old population,’’ those aged 85 and

older, represents the fastest growing segment among older persons

in our Nation. This group is disproportionately frail and among the

most vulnerable to excessive housing cost burdens. To be more specific, there are about 4.6 million Americans aged 85 and older in

2002. That number is projected to increase by more than 70 percent, to approximately 7.3 million, by 2020.

Clearly, powerful demographic forces are at work. By 2030, the

number of persons age 65 and older will increase to 20 percent of

the population, and much of this growth will be driven by large increases in the number of persons age 75 and older. AARP supports

enactment of S. 705, Meeting the Housing and Service Needs of

Seniors Act of 2005. The need for greater coordination is particularly apparent when trying to put together the housing, health, and

social service programs at all levels of government that are critical

to successfully serving people with disabilities of all ages.

Research has shown that Federal housing programs have very efficiently, if inadvertently, identified those who are at high risk of

needing supportive services in order to remain independent. Analysis by AARP’s Public Policy Institute of data from the 2002 American Community Survey found that compared to older homeowners,

older renters in subsidized housing were much older. Half of the

renters in subsidized housing were 75 or older, compared to just

over one-third of older homeowners.

It found it twice as likely as older homeowners to experience

physical and cognitive limitations that threaten their ability to live

independently, and it found it more than three times as likely as

older homeowners to live and have weak informal supports from

family and roughly three times as likely as older homeowners to

be at high risk of needing Medicaid assistance due to low incomes

and high levels of disability.

Better coordination of housing, health, and social service programs would serve a variety of purposes, but the most compelling

case for better coordination comes from the lives of our older people

who need assistance. The older woman who is clinging to independent living in her apartment but has no one to help her bathe

or just get out of the tub; the older man who is told he has to move

to a nursing home to get housekeeping services; or an older disabled resident in a nursing home who might have been able to

leave if suitable housing and services were available.

AARP research consistently documents that as Americans pass

through mid-life, regardless of whether they own or rent their

housing, we, by and large, prefer to remain in our own homes. But

the adaptability of housing to the processes of aging in place presents different challenges for housing facilities that have not often

been designed with these life changes in mind.

Mr. Chairman, if we continue to accept poor coordination among

providers of housing and housing related services, we will see an

America with an even greater number of underhoused, underserved

older citizens and a corresponding substantial increase in costly

and premature institutionalization of older people. S. 705 is a worthy first step as we begin to address these problems. We urge its

speedy enactment.

21

Thank you again for this opportunity to testify, and we would be

very happy to answer any questions.

Chairman SHELBY. Thank you.

Ms. OLSON.

STATEMENT OF DANA OLSON

EXECUTIVE DIRECTOR, VOLUNTEERS OF

AMERICA’S LAUREL MANOR SENIOR RESIDENCE,

COLORADO SPRINGS, COLORADO

Ms. OLSON. Chairman Shelby, Senator Sarbanes, and Members

of the Committee, I am Dana Olson, Executive Director of Volunteers of America Laurel Manor Care Center in Colorado Springs,

Colorado, and Regional Health Care Manager of 11 Volunteers of

America senior residences in Colorado, Nevada, and California.

In that capacity, I also supervise the opening and initial operations of our senior residence in Senator Allard’s home town of Fort

Collins, Colorado. I have worked for 34 years in long-term care,

about 15 years of those years as Director of Nursing and the rest

as a Nursing Home Administrator. Volunteers of America is one of

the Nation’s largest and most comprehensive charitable, nonprofit,

spiritually based human service organizations. In 2004, Volunteers

of America’s services across the country sought to empower over

135,000 seniors to maintain a healthy, engaged quality of life

through senior centers and day programs, home repair and homemaker services, information and referral services, Meals on Wheels

and group meal programs, transportation, companion services,

elder abuse protection, case management, and coordination of other

community services.

On behalf of our organization, I want to express our sincere appreciation for your interest in Senate Bill 705, the Meeting the

Housing and Service Needs of Seniors Act and concern for the

needed coordination between housing, health care, and supportive

services for the growing population of seniors in the United States.

In a recent study, the State of the Nation’s Housing 2001, the Joint

Center for Housing Studies of Harvard University reported that

heads of household over the age of 75 are expected to increase by

roughly 1.3 million over the decade. They go on to say that this

growth implies rising demand for housing that allows seniors to

age safely in place and for specialized facilities such as assisted living and continuing care communities.

Clearly, as a Nation, we have a problem of extraordinary scale

and urgency, as the housing and social service programs and funding we have in place today will not keep pace with this situation.

As people grow older in residences designed only for independent

living, they are at high risk of being forced into institutional nursing home care or alternatively having their needs unmet.

Much of this problem is due to the fact that the delivery of services to many persons is fragmented because of multiple policymaking authorities and funding streams, conflicting regulations,

and poorly coordinated overlapping Federal and State government

agencies. This fragmentation is not only costly; but it also oftentimes leads to serious gaps in providing what is needed.

It is because of this existing fragmentation that passage of Senate Bill 705, the Meeting the Housing and Service Needs of Seniors

22

Act, is so important as a step in the right direction to better coordinate our housing programs and related services, so seniors can age

in place and have access to needed services.

Let me tell you a little about my experience in Colorado. As the

administrator of a skilled long-term care center, I am seeing older,

more frail, acutely ill seniors coming to us for care and rehabilitation to allow them to return home or to a lesser level of care in the

continuum. As the people we care for come to us much more acutely ill, and the regulations under which we operate become more

and more stringent, the fragmented system is more difficult to

work with.

We never want to be in a position that limits the services we

need to provide to give our residents the highest quality of service

possible, but we need your help to do so. As the Regional Housing

Manager of five 202 senior housing complexes in Colorado, we have

a waiting list of over 200 seniors. That means 200 seniors are out

there in need of our services, and we are not able to meet those

needs at this time.

This only reinforces the need for more available services for our

seniors. The best way to meet this need is to have adequate funding to build additional senior apartment facilities with a service coordinator in each facility. The person would have the capability of

assisting our seniors access the system to fill the need for food,

medical care, and other supportive services.

But even good service coordinators have difficulty unraveling the

myriad rules, regulations, agency sources, and funding streams

that are intended to serve senior citizens. Passing this legislation

and establishing a Federal Interagency Council on meeting the

housing and service needs of seniors would provide a structure for

a Federal agency to jointly review housing and service programs,

more effectively coordinate Federal programs and services, and

work with States to coordinate programs and services at the State

and local level.

For the sake of our Nation and its deserving senior citizens, we

must find an efficient, well-coordinated means of providing longterm care through integrated health care with supportive services

and housing, and that process has to start at the top. That is why

Volunteers of America believes that the Meeting the Housing and

Service Needs of Seniors Act must be passed as a bipartisan testimony to the worth of our older generations.

We appreciate the opportunity to bring you our ideas and perspectives and want to ensure all of the Members of the Committee

that Volunteers of America is strongly committed to helping resolve

these issues before the growing demand for elderly housing and

supportive services spirals out of control. We are confident that

sound solutions can be found and implemented in a way that is fiscally responsible and fair to all parties.

Thank you.

Chairman SHELBY. Mr. Proctor, I just wanted to mention, as you

well know, Senator Santorum was here earlier. He is a Member of

the Finance Committee. They are having a markup, and he wanted

me again to reiterate if he could be here, he would like to acknowledge your presence.

Thank you.

23

STATEMENT OF STEPHEN PROCTOR

PRESIDENT AND CEO, PRESBYTERIAN HOMES, INC.

RETIREMENT AND SENIOR CARE SERVICES,

CAMP HILL, PENNSYLVANIA

Mr. PROCTOR. Thank you.

Chairman SHELBY. Go ahead.

Mr. PROCTOR. Good morning, Mr. Chairman and distinguished

Members of the Committee. I am Steve Proctor, President and CEO

of Presbyterian Homes, headquartered in Camp Hill, Pennsylvania,

and I am honored to be able to provide you with some testimony

today on behalf of Presbyterian Homes and the Pennsylvania Not

for Profit Homes Association, the principal association that provides representation for faith-based providers of senior services.

As was mentioned earlier, the population we serve in Pennsylvania is among the Nation’s oldest and, in many areas of the State,

requires a significant amount of care. We have 15 facilities in

Pennsylvania, but we also have facilities in Maryland, Delaware,

and Southeastern Ohio. Some are located in urban areas; others

are located in some of the most rural places you can imagine.

We provide a full continuum of care for Pennsylvanians in need

of chronic care. Seniors in some of our locations are younger individuals with disabilities. Our staff, about 2,600 individuals, provides housing and services to more than 3,000 residents Statewide,

and we are very proud of the history of 80 years of service or providing this kind of care.

When I was first told about the intent of S. 705 and asked to testify, I was a little skeptical. Historically, proposals to initiate this

type of council have been many, and the solutions coming from

them have not always lived up to their original billing. But when

I read Senator Sarbanes’ bill and comments during the introduction of this piece of legislation, we discovered that it was very consistent with PANPHA’s Strategic Initiative on Consumer Choice.

That is, housing and services alignment driven by consumer need,

not the wishes of often well-intentioned bureaucrats and funding

agencies.

We strive toward this goal because it is how consumers wish to,

and deserve to, receive the services they need and want. In short,

this bill makes sense. The coordination proposed in S. 705 is not

only necessary; it is long overdue and will provide real enhancements in the delivery of housing and services to the people we

serve.

As a provider of housing and services, I thought my time before

you would best be focused on some specific examples of how things

work in terms of the statutory regulatory and funding maze that

is out there. PHI is a sponsor of Stadium Place, a model for senior

housing located on the site of Memorial Stadium in Baltimore. The

site currently contains HUD housing, tax credit housing for seniors, market rate and homeownership developments to follow. It

shares a site containing a full service YMCA and has developed to

provide seniors with limited incomes many of the same options

available only to more affluent seniors of continuing care retirement communities.

A recent editorial in the Baltimore Sun identified Stadium Place

as the right model for senior housing. More importantly, many of

24

the residents of Stadium Place describe it as the best place they

have ever lived, and if you have not seen this project, I would encourage you to visit this site.

But the key to really realizing the dream of Stadium Place Memorial Stadium and other senior housing projects of similar scope

is the delivery of supportive services in an environment that can

best and most charitably be described as fragmented. The combination of case management, coordination of existing services, and

flexible delivery service systems will enable this group of seniors to

live more healthy and active lives.

The timely intervention of health and social services will ultimately save money by helping residents of Stadium Place to age in

place. Aging in place is obviously what people desire if their needs

can be met, and that is if their needs can be met. PHI has a person

in one of our facilities who has been in that particular project since

being admitted with her disabled husband in 1970, so she has really aged in place. We are able to meet her needs, and that is becoming more increasingly difficult as she is in her mid- to upper 1990’s.

Without better coordination among and across the agencies that deliver services to her, it is doubtful that we can provide a continued

opportunity for her to age in place as she would prefer.

There are many examples of the housing and service needs of

seniors not matching up with inflexible regulations and program

requirements. There are a couple of examples of this that are listed

in my printed testimony. They are very obvious in terms of not providing the ability for services to follow people to the place they are

moving to. You will see examples of people not having services follow them. Their needs have changed; their income has not

changed, but where they live has changed.

You will find that there is a tremendous amount of support not

only among service providers but among the people we serve for

this as they struggle to find their way through one application

process after another or struggle to find services at all. They would

be here with me today supporting and seconding all of this.

I will not go over all the statistical evidence of Pennsylvania and

all of the seniors we have to serve. That is well-documented and

actually frightening, but I would like to second my colleagues’ opinions up here in terms of supporting this bill. It is a wonderful bill.

We hope it realizes the promise that we all expect from a first rate

effort.

Thank you.

Chairman SHELBY. Thank you.

Dr. Smith.

STATEMENT OF WILLIAM T. SMITH, Ph.D.

CHAIR OF THE BOARD, AMERICAN ASSOCIATION OF HOMES

AND SERVICES FOR THE AGING (AAHSA)

Mr. SMITH. Chairman Shelby, Ranking Member Sarbanes, and

Members of the Committee, I would like to thank you for inviting

me to appear before you today to discuss Senate Bill 705. I have

submitted written testimony for the record, so for my comments

this morning, I would like to talk to you about the real world experience of providers and seniors we serve as well as the opportuniVerDate 11-MAY-2000 18:43 Nov 20, 2006 Jkt 025856 PO 00000 Frm 00028 Fmt 6633 Sfmt 6633 30792.TXT SBANK4 PsN: SBANK4
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ties that this bill presents for making service delivery and program

administration less cumbersome and more responsive.

My name is William Smith. I am the Chair of the Board of the

American Association of Homes and Services for the Aging,

AAHSA. AAHSA members serve 2 million people every day in

5,600 facilities throughout this country through mission-driven, not

for profit organizations dedicated to providing the services people

need when they need them in a place that they call home.

AAHSA members offer the continuum of aging services: Assisted

living residences, continuing care retirement communities, nursing

homes, home and community based services, and senior housing.

Our commitment is to create the future of aging services through

quality that people can trust. It is this commitment that underlines

our support for this legislation, its goals, and increasing the effectiveness and collaboration amongst Federal programs that serve

our seniors.

In addition to my work with AAHSA, I serve as the President

and CEO of Aging in America, a community-based organization

that originated in 1852 with a mission of providing housing for

aged women and has evolved into a full service organization employing over 550 staff that serve over 5,000 seniors annually, primarily in the Bronx but also in the neighboring areas of New York.

I know firsthand how complicated and difficult it can be to work

with a patch quilt of programs to create the range of housing and

services necessary to care for seniors with varying degrees of frailty

and need. In 1972, Aging in America developed a skilled nursing

facility for 386 residents and later established a continuum of community-based services. In 1978, we converted a 90,000 square foot

former high school into our social service agency, including a number of community based activities, intergenerational programs, Alzheimer’s day care center, case management, victims assistance,

elder abuse, and, frankly, support for grandparents raising grandchildren.

We opened our first senior center in 1979, and since then, we

have had two off-site senior centers and four satellite programs

providing recreation, education, information, referral, wellness programs, et cetera, to over 1,500 older New Yorkers weekly. We delivered hundreds of meals and last year provided nearly 300 seniors

with 3,465 trips to medical and social service providers.

In order to help clients navigate the maze of Federal, State, and

local programs, we have developed a comprehensive case management program that provides services for over 700 elderly New

Yorkers conducting in-home assessments and authorization of the

delivery of in-home personal care, housekeeping services, and home

delivered meals. We have a 17-bed temporary housing unit that

provides respite, emergency, and permanent living arrangements

for people over 60.

Senate Bill 705 is integral to the goals and policy laid out by the

Commission on Affordable Housing and Health Facility Needs for

Seniors in the Twenty-First Century. The demographics compiled

by that Commission are staggering. Today’s seniors comprise 12.4

percent of our population. That is 35 million people. By the year

2030, that number will have doubled: 70 million seniors, 20 percent

26

of our population. I live in Westchester County, and 20 percent of

Westchester County is already above the 65 year age group.

One of the Commission’s primary recommendations was a call for

the coordination of housing and health care among departments,

stable, affordable housing settings. Those places that seniors call

home are the cornerstone of service delivery. I cannot overstate the

importance of bringing services to these housing settings among all

income levels. In 2020, those seniors that will need some form of

assistance will be 5.8 million homeowners, 1.5 million unsubsidized

renters, and almost 600,000 with some form of rental assistance.

The Federal and State governments did not set out to create a complicated, contradictory, sometimes duplicative system of programs

and funding mechanisms for serving those who are most in need,

but unfortunately, that is what we have.

With over half of our senior population at 75 years of age and

older, we need to do a better job of making and coordinating that

array of services. Senate Bill 705 is a significant step in that direction. It really is landmark legislation, and we strongly support it

and support in particular the use of common vocabulary, common

age for eligibility, common definition of eligible populations and

standards for programs.

Chairman Shelby, Members of the Committee, I want to thank

you for your time this morning. I would certainly like to thank Senator Sarbanes for introducing this legislation and taking this important first step. And frankly, I would like to thank the other

Committee Members also for their support for this very important

legislation.

Thank you.

Chairman SHELBY. Ms. Allton.

STATEMENT OF TERRY ALLTON

VICE PRESIDENT FOR SUPPORT SERVICES

NATIONAL CHURCH RESIDENCES

Ms. ALLTON. Good morning, Chairman Shelby, Ranking Member

Sarbanes, and other Members of the Committee. My name is Terry

Allton. I am Vice President of Support Services at National Church

Residences. We are a nonprofit housing and supportive services

and health care provider based out of Columbus, Ohio. We employ

154 service coordinators throughout the United States who provide

services to our seniors. I am very excited to be here today to talk

about housing and supportive services and especially the Senate

Bill 705.

Congress’ establishment of the service coordinator program

launched a profession with the sole purpose of addressing quality

of life issues for the elderly, offering possible solutions to aging in

place. The service coordinator program is the Interagency Council

in action. The goal of a service coordinator is to link residents with

services that exist in the community, allowing them to remain

independent, in their own homes, and avoiding the premature institutionalization that they so fear.

The primary function of a service coordinator is to work with

service delivery systems, provide resource information, identify programs, and assist seniors through the labyrinth of regulations attributable to a multitude of government agencies. Our elderly resiVerDate 11-MAY-2000 18:43 Nov 20, 2006 Jkt 025856 PO 00000 Frm 00030 Fmt 6633 Sfmt 6633 30792.TXT SBANK4 PsN: SBANK4
27

dents typically do not know who supplies which services or that

some services even exist within their community, and that is why

the prospect of the Interagency Council is so exciting.

National Church Residences is a founding organization of the

American Association of Service Coordinators. This is a national,

nonprofit organization representing more than 1,500 service coordinators who serve more than 400,000 low-income elderly across the

United States. Like others on this panel, National Church Residences is an active member of AAHSA and its State affiliate, the

Association of Ohio Philanthropic Homes, Housing, and Services for

the Aging. I am here also representing AASC, the American Association of Service Coordinators, as the current Chair of their Board

of Directors. AASC has long urged that housing, health care, and

other Federal support programs serving the elderly join together to

better focus Federal policy and regulatory efforts in conjunction

with States and communities. Senate Bill 705 will do exactly that.

Before I talk about our service coordinator program, I would like

to talk about NCR’s commitment to the preservation of affordable

housing and serving residents as they age in place. NCR has long

advocated for Congress to recognize the importance of preserving

existing affordable housing and helping residents at risk of losing

their housing as providers opt out of HUD programs and sell or

convert their properties to market rate.

We are losing more senior housing than we are currently building. This means that seniors are and will be in a precarious position to meet their housing and service needs unless we are able to

preserve affordable housing. Housing services go hand-in-hand for

seniors who are aging in place. One without the other spells disaster for residents as they become frailer, with limited options and

fewer resources. Service coordinators serve as a lifeline for seniors

in all manner of housing settings and have become an increasingly

important part of our older senior housing communities, where people have lived 20-plus years aging in place.

For individual residents, service coordinators do, on the local

level, or at best try to do what this legislation would do at the Federal level, by coordinating what is frequently referred to as a crazy

quilt of health, housing, and service programs that are used by seniors, service coordinators, and properties. They identify resident

needs; they work within the community to locate existing resources: And they provide service management to organized health

and wellness programs so that residents who live in these communities who do not know services exist, they broker those services

and bring those services to the residents.

They offer one-on-one help for residents by providing intensive

assistance, helping residents understand insurance, Medicaid,

Medicare, entitlement programs, and benefits that they might not

even know that they are eligible for. They act as a broker for services that are difficult to obtain through public resources and assist

residents in securing the help that they need to live safely and

independently through community agencies.

The first stage of providing a continuum of housing and service

choices for the elderly is in home supportive services. Navigating

through a system of segmented service providers and benefits is

often difficult for older persons and their families. As I said, service

28

coordinators are the Interagency Council in action. Their lives and

jobs will be made a lot easier by Senate Bill 705, not to mention

what it will mean to seniors and family caregivers who might be

unfamiliar with the aging services field.

In addition to navigating services which should be made easier

by this legislation, service coordinators help elderly residents take

advantage of cost saving programs such as prescription drug discounts so that the elderly are not choosing between paying the

rent, buying food, or getting their prescription drugs. Service coordinators also provide a cost saving benefit to subsidized housing

communities, saving those communities money by preventing unnecessary vacancies when residents might go on to a long-term care

or some type of situation that they might not need.

So, I will end my comments at that point. I thank you very much

for letting me present today, and I will entertain questions later.

Chairman SHELBY. Thank you.

Mr. Protulis.

STATEMENT OF STEVE PROTULIS, EXECUTIVE DIRECTOR

AND VICE PRESIDENT, ELDERLY HOUSING

DEVELOPMENT AND OPERATIONS CORPORATION (EHDOC)

Mr. PROTULIS. Thank you, Mr. Chairman. I really appreciate the

opportunity to share with you some of my frustration of the last

few years.

First of all, I want to thank you, Mr. Chairman for having a

great staff on the basis that, in my opinion, Mark is one of the

greatest assets you have, and the Chairman is not hearing you,

Mark, I am sorry, but he will.

[Laughter.]

Mark is an outstanding young man you have working for you,

sir, and I want you to know that he needs a raise.

[Laughter.]

Chairman SHELBY. I agree. He needs to be better paid.

[Laughter.]

Mr. PROTULIS. Yes, sir. That is exactly right.

Senator SARBANES. There is a law against lobbying the Congress

on——

[Laughter.]

Mr. PROTULIS. Okay; I plead the Fifth.

The truth of the matter is I have gone through many notes, and

I have already submitted my written testimony, so I want to be

brief and just speak from my heart instead of my notes.

And I just wanted to share a couple of things. I wanted to just

bring quickly, in my opinion, an observation that is real because

it is in this room. There is a lady in a wheelchair sitting in the

back; Mary, would you please wave?

Chairman SHELBY. Hold her hand and identify her. I see her.

Mr. PROTULIS. Thank you, Mr. Chairman.

Mary lives in our property in Maryland and she was very depressed, because her doctor, on the basis of frailty, told her that

you need to go to a nursing home. Now, here is an example: If you

took the time to listen to her agonizing personal feeling—no matter

what the physician says—but an individual being told that you

have to move from your home, from your place that you are comVerDate 11-MAY-2000 18:43 Nov 20, 2006 Jkt 025856 PO 00000 Frm 00032 Fmt 6633 Sfmt 6633 30792.TXT SBANK4 PsN: SBANK4
29

fortable, and go someplace that is new and scary, it was something

she did not want to deal with, and the depression took over.

Our service coordinator, actually took time to find an organization that will provide the means so she can age in place, and today,

she remains in her place, and through the PACE program, we were

able to provide for her needs so that she was able to age in place

and be happy. With that example, Mr. Chairman, you can see there

are thousands of other stories where we can keep seniors living in

the same area and be happy because they are getting their needs

met and the service they need.

Prior to working on this bill, I was actually wearing a different

hat. I was appointed by this illustrious, great Senator from Maryland, Senator Sarbanes, to a commission. And when I took that job,

I was probably the most ignorant person among all the commissioners. And when we went through hearings and listened to the

testimony from all kinds of experts and knowledgeable people like

on this panel, I was mystified to the lack of knowledge that I had

myself and the fact that even in our own commission, which we

were given a very short window, 18 months, they cut us $800,000,

so we could not get enough witnesses to bring forward; we only had

six hearings around the country.

We managed to come out with recommendations, and Mr. Chairman, I have this book here, and I want you to know it is does not

have all the answers in here, but there is plenty of information. So

having this agency, Mr. Chairman, and you having the leadership

to follow the wishes of a great Senator like Sarbanes, where is the

question—who can be opposed to this? Who can be opposed to giving seniors a choice? And you know, the only statistic we have in

this country are the provisions that we have when we provide services to poor seniors, because it is an inadequate system, because it

comes with resources from the Federal Government.

But do you know that every single one of us in this room sooner

or later, if it already did not happen, will have to face a reality like

the Secretary of HUD mentioned earlier about his mother’s decision to stay in her home. And what is available out there? There

are some great stories where people have been provided great benefits through the private sector, government assistance, States doing

great work, stories that we do not even know exist today in trying

to keep that senior aging in place.

So, I just want you to know that the timing is almost too late,

but it is important that we are doing something expeditiously and

urgently. I just had the privilege yesterday morning to attend an

AARP conference where there were over 350 delegates from all

over the world to discuss aging in place. The Premier of British Columbia testified in front of all of us. And one of the issues that was

mentioned about the agencies that are set up in his own province,

how difficult it is to tell bureaucrats from an agency you have to

compare notes with someone else, as it was addressed this morning, and it is a major issue.

So the mandate to make this Interagency follow the rules and

learn the best stories out there, not just the resources coming from

the Federal Government but how we can make those seniors feel

there is a place where they can make choices and compare notes.

Thank you for the opportunity to testify.

30

Chairman SHELBY. Thank you.

Mr. Wood.

Senator SARBANES. Mr. Chairman.

Chairman SHELBY. Yes, Senator Sarbanes first.

Senator SARBANES. Mr. Chairman, I am going to have to leave

the hearing, because there is another group that has come from my

State that we had early on arranged to be here. I do want to thank

all the witnesses for their testimony and for the very strong statements. I have looked through these statements, and we very much

appreciate the obvious care and effort that went into preparing

these statements. These are very valuable in building a record in

support of the legislation, and I am very hopeful that we will be

able to move ahead on this legislation and provide the kind of support that it would give to the work that you are doing.

And I do want to thank you once again for the work you are

doing. It is enormously important.

Chairman SHELBY. Thank you, Senator Sarbanes.

Senator SARBANES. Thank you.

Chairman SHELBY. Mr. Wood.

STATEMENT OF DAVID G. WOOD, DIRECTOR,

FINANCIAL MARKETS AND COMMUNITY INVESTMENT

U.S. GOVERNMENT ACCOUNTABILITY OFFICE

Mr. WOOD. Thank you, Mr. Chairman, and I thank you and the

Ranking Member for inviting me today.

My statement is based primarily on our recent report concerning

Federal housing assistance programs to benefit the elderly. The report was requested by the Senate’s Special Committee on Aging,

which was particularly interested in the availability of supportive

services for the elderly who reside in federally assisted housing.

Federal programs aid the provision of housing in a variety of

ways, ranging from financing the construction and rehabilitation of

units to helping pay rents. With few exceptions, the programs are

not specifically directed at the elderly, although many can and do

benefit from them. We identified a total of 23 Federal assistance

programs whose beneficiaries explicitly include the elderly; two

that are targeted exclusively to the elderly; three that are targeted

exclusively to the elderly or the disabled; 18 that have special provisions for the elderly such as income adjustments that make it

easier for them to qualify.

These programs do not reach all eligible households, and waiting

lists are often long. Only 4 of the 23 housing assistance programs

require that participating property owners ensure the availability

of supportive services. For example, HUD Section 202 programs

subsidize the development and operating cost of multifamily properties, exclusively for the low-income elderly. Owners must ensure

that residents have access to transportation and other services.

The Agriculture Department’s Congregate Housing Program

funds the development of independent living facilities, which must

provide meals, transportation, housekeeping, and personal services.

Neither HUD nor Agriculture provide funds under the four programs for supportive services. However, HUD does offer grants and

other assistance that can be used to provide some services to elderly residents of federally assisted housing. Property owners typically

31

obtain needed funds from a variety of sources, including HUD’s or

other Federal programs or form partnerships with local charities or

nonprofits to provide services.

For health care, a key source is the Department of Health and

Human Services. For example, the Department’s Public Housing

Primary Care Program provides some elderly public housing residents with primary and preventive health care through on-site clinics, while the Medicaid Home and Community Based Services

Waiver program enables elderly residents to receive needed health

care in their current homes, including federally assisted housing.

We do not have comprehensive data on exactly what services are

provided to the elderly or how they are funded at all Federally assisted housing programs. However, given the range of programs

and funding sources, it is likely that they vary considerably. As the

Seniors Commission report illustrates, many elderly Americans can

be expected to need both housing and health care services in the

future. This is yet another case in which achieving a Federal goal

requires the concerted and coordinated efforts of two or more agencies. However, GAO’s work has shown that a number of barriers

inhibit coordination among agencies. These include missions that

are not mutually reinforcing or that may even conflict, concerns

about protecting jurisdiction over missions and control over resources, and incompatible procedures, processes, data, and computer systems.

Addressing the potentially large service needs of a growing elderly population will call for effectively overcoming these or other barriers. That concludes my prepared statement. I will be glad to answer any questions you have.

Chairman SHELBY. I want to thank all of you, and I also want

to again thank Senator Sarbanes for his leadership in this area. I

have several questions, and I will ask, and then, I will have some

for the record.

It is very important here as far as the topic. S. 705 would charge

an interagency council with making recommendations for streamlining Federal housing programs and services for seniors. That is

what we are trying to get at.

Mr. Wood, GAO’s February 2005 report, which you have alluded

to, states that there is little available information about the effectiveness of these housing programs serving the elderly. We want

them to be effective, though. What criteria, Mr. Wood, do you believe that the council should use in making its recommendations?

In other words, your testimony refers to existing program missions

that are not mutually reinforcing and sometimes conflicting.

Mr. WOOD. Right.

Chairman SHELBY. Should Congress require the Council to establish goals, Federal goals for seniors’ housing and services, goals

against which the performance of all of these programs should be

judged or would be judged?

Mr. WOOD. I think we have in several, a couple of reports in the

past stressed a couple of things that have already been mentioned

at this hearing this morning. One was by Senator Allard when he

talked about the Government Procedures and Results Act. We have

testified and reported on many occasions that that offers a good

framework for both establishing goals and for promoting coordinaVerDate 11-MAY-2000 18:43 Nov 20, 2006 Jkt 025856 PO 00000 Frm 00035 Fmt 6633 Sfmt 6633 30792.TXT SBANK4 PsN: SBANK4
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tion. It is actually a required element of agencies’ strategic plans,

their annual plans, and their annual reports to report on the extent

of coordination that they have engaged in with regard to crosscutting——

Chairman SHELBY. It makes a lot of sense, does it not?

Mr. WOOD. Absolutely.

Chairman SHELBY. Senator Allard is very involved in the housing, and Ms. Olson and everybody else knows, and is a senior Member of this Committee. He has done a lot of work in this area.

Mr. WOOD. Right; the other thing that I would mention, again,

that came up this morning is we have long said that it requires—

effective coordination requires a commitment at the top, and by requiring the Secretaries themselves to be part of this Council it addresses that.

Chairman SHELBY. Be very involved.

This type coordination could be, as you know better than anyone,

the coordination of services to the elderly to let them live in place

could be one of the biggest cost savings for the American people

and also could be something that the elderly want to do.

Mr. PROTULIS. Absolutely.

Chairman SHELBY. I do not know myself of any of the elderly

that would not rather stay in their home, as you have pointed out,

where they are comfortable, something that they are used to. This

is just common sense, human nature, is it not, Mr. Protulis?

Mr. PROTULIS. Not only that, Mr. Chairman, but also in these

days of cuts in Medicaid and Medicare, we prove over and over by

keeping them at their home and providing service, we save money,

which is something——

Chairman SHELBY. Save billions and billions of dollars.

Mr. PROTULIS. And there have never been statistics shown, and

it is for real. It exists.

Chairman SHELBY. I think you are absolutely right.

I am going to reference S. 705 again. We all have. It would allow

State and local representation on the Council. I believe this is an

important element to have the representation, have the involvement. As many housing, health care, and transportation programs

as we all know are carried out by the State and the local governments. S. 705 directs the council to select these representatives.

To any of you, would you like to comment, would this be a workable process? Should Congress specify a particular number of State

or local representatives? Should Congress also specify a more detailed method of choosing which State and local representatives

should serve on the Council? Or should that be left up to the Council?

Who wants to tackle that?

Mr. Protulis.

Mr. PROTULIS. I just personally think that my initial reaction is

that there has been such overwhelming need to have community

involvement so we can safeguard not only the policies already established by the Government but also where the best stories are,

where the real good stories are taking place, and they are on the

local level. So how do we go about structuring that? I would say

that the more involvement in the community it is, the better off it

is going to be.

33

Chairman SHELBY. Sure.

Mr. PROTULIS. And I also want to add one more: If you ask those

30-some seniors sitting behind us which is the number one issue

outside of the health care needs, transportation is critical. And I

think that department of our agency of the Government also can

play a critical role in how we provide transportation, because transportation, when they give up their car, depression sets in; they sit

in their room; they do not want to leave. So just housing in place

is important to aging in place, but keep them involved in the community, and that transportation is a critical element.

Ms. BARNETT. Mr. Chairman, may I comment on this also?

Chairman SHELBY. Yes, Ms. Barnett.

Ms. BARNETT. I come from a rural area, and transportation is

very important. We do not have access to public transportation in

only two small areas there. But the cost of transportation is so extremely high that our providers are saying if we go bring a person

in to a medical facility, we have to have three of these people to

bring in for it to be cost-effective for us. So they cannot bring one

in, delaying health care at that point. So this is another reason

that I feel that this is so very important, that if we can provide

these services in facilities to keep them aging in place that it is

very important to do so.

Chairman SHELBY. Thank you.

Ms. BARNETT. I strongly support this bill.

Chairman SHELBY. Dr. Smith.

Mr. SMITH. You know, I get teased by the adage that all politics

are local.

Chairman SHELBY. Well, there is a lot of truth in it.

Mr. SMITH. I know, I know.

Chairman SHELBY. A lot of us that run for public office recognize

that.

Mr. SMITH. Know that law very well.

[Laughter.]

I think it is important that the Federal Government and through

this excellent bill really model how this can be done. I think that

clearly, the Secretaries of both major agencies should be mandated

to be in attendance for at least a period of time of 2 or 3 years,

something like that, and then, perhaps, 50 percent of the meetings

going on from there if it is necessary.

But I think the leadership at the top is key. I think for the Commission to appoint—I mean, somehow, they have to solicit recommendations from the local area and get some endorsement from

the key players in States or cities. I come from New York that has

not found a Federal law that it cannot embrace and enhance, so I

get nervous about more regulations coming down the line.

I think where the Commission could clearly help us with that

leadership is also looking at common language, common eligibility

rules, age rules. I mean, I work with seniors that as they age in

place and get older, they fall out or fall ineligible for different types

of programs to let them still age in place. So, I think we really have

to insist upon common definitions. And forcing these agencies to

work together, be in the same room once or twice a year, maybe

even more than that, would be a wonderful first start.

34

Chairman SHELBY. Well, I really like the term coordination more

than regulation.

Mr. SMITH. Yes.

Chairman SHELBY. And if we can coordinate, it is more than just

common sense. I think you have all demonstrated it. You are involved in it. And I think this is a worthy piece of legislation if we

can make it, pass it, and make it work, and if we are able to pass

this type of legislation, it will be meaningful, but it will be a heck

of a lot more meaningful if it is coordinated and worked, implemented, executed, so to speak.

Mr. SMITH. And AAHSA would certainly stand ready to help the

Committee find additional sponsors around the country to really

get this legislation passed. So many people will benefit by it.

Chairman SHELBY. You make it bubble up locally.

Mr. SMITH. Absolutely.

Chairman SHELBY. We feel it here, as you know.

I want to thank you all for your appearance but more than that

for your involvement. You are committed to a worthy goal.

The hearing stands adjourned.

[Whereupon, at 11:55 a.m., the hearing was adjourned.]

[Prepared statements, response to written questions, and additional material supplied for the record follow:]

35

PREPARED STATEMENT OF SENATOR DEBBIE STABENOW

Mr. Chairman, thank you for calling this hearing. And, thank you Senator Sarbanes for championing this issue. I could not agree with you more that better coordination of our Federal resources aimed at assisting seniors is one that needs attention. With seniors comprising more than 12 percent of the Nation’s population and

that number increasing every year, we must begin putting in place the infrastructure necessary to handle the broad array of services that seniors draw upon each

day.

My home State of Michigan has more than 1.2 million residents over the age of

65 and they will all benefit from a more efficient coordination of the services that

assist with their housing and other necessary services.

As we know, many of our seniors need assistance with their daily activities. Other

seniors need assistance with medication, meals, transportation, health care, and

other needs. And, right now, we do not do a great job in matching up a person’s

housing needs with the way we deliver these vital services.

There are so many ways we can improve our safety-net services to make them

more effective. As a Member of the Senate Agriculture Committee, I have seen that

also happen with our Federal nutrition programs.

I have meet with food banks that are frustrated that many seniors they would

like to help are not eligible for USDA’s important nutrition program—the Commodity Supplemental Food Program (CSFP). That is because seniors cannot deduct

the cost of their medications when seeking eligibility for food assistance. We have

people who are literally deciding between their food and their medicine. In a Nation

as great as ours, this is outrageous!

As Senator Sarbanes has pointed out, the current programs and services that assist the elderly in meeting their needs are spread across numerous Federal agencies,

making it difficult for seniors to understand and access needed services.

For instance, the Congressionally established Seniors Commission, found in its

2002 report that the most striking characteristic of seniors’ housing and health care

in this country is the disconnection of one field from another.

Senator Sarbanes is moving us toward a solution. His bill, S. 705, would create

an executive level Interagency Council on Meeting the Housing and Service Needs

of Seniors to better coordinate housing programs and related services so that senior

citizens can age in place and access needed services.

I support his efforts and look forward to the testimony of the witnesses. Thank

you.

—————

PREPARED STATEMENT OF ALPHONSO JACKSON

SECRETARY, U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT

JUNE 16, 2005

Chairman Shelby, Ranking Member Sarbanes, distinguished Members of the

Committee, thank you for inviting the Department to testify on the ‘‘Meeting the

Housing and Service Needs of Seniors Act of 2005,’’ legislation intended to better

coordinate housing programs and related services so that senior citizens can age in

place and access needed services.

I commend the Ranking Member for bringing this matter to the attention of the

Committee.

The Committee has asked the Department to discuss the changing senior population and its housing needs. This includes the ability of seniors to access programs

and services that will allow them to age in place; the Federal role in better preparing to meet the needs of seniors, particularly as it relates to our partnerships

with State and local governments and the private sector; and how an Interagency

Council on Meeting the Housing and Service Needs of Seniors could assist and coordinate these efforts.

The Changing Senior Population and Its Housing Characteristics

The senior population—those aged 65 and over—continues to grow. In the last

decade, the elderly population has increased 10 percent. That is an impressive figure considering that those turning 65 in the last 10 years were born in the 1930’s,

and are the children of the Great Depression, which was a ‘‘baby bust’’ generation.

The fact that the elderly population is growing at such a steady rate reflects both

immigration and advances in the Nation’s extraordinary health care system. We can

be sure that the growth will accelerate. Over the next 5 years, we will have the children of the World War II generation turning 65, followed by the Baby Boom generaVerDate 11-MAY-2000 18:43 Nov 20, 2006 Jkt 025856 PO 00000 Frm 00039 Fmt 6621 Sfmt 6621 30792.TXT SBANK4 PsN: SBANK4
36

tion. With that on the horizon, we have every reason to believe that the number

of seniors will double by the year 2030. By then, the Census Bureau estimates that

20 percent of Americans will be older than retirement age.

The elderly population is geographically and culturally diverse, and this will

present additional challenges in the coming years. For instance, in many minority

communities, the culture is to have the grandparents live out a life of a dignity not

in an institution, but rather surrounded by family and friends at home. With the

rapid growth in the Nation’s ethnic and minority communities, these dynamics will

become more profound in the future.

Clearly, this Nation will need to address the issue of senior housing from a different perspective than we have in the past.

How HUD Programs Support the Senior Population

As the Committee knows, HUD has a long history of providing housing and delivering related services to one of the Nation’s most vulnerable populations: The

low- and very low-income elderly. The overall aging of the population and the corresponding need for elderly housing has prompted the Department to make changes

in a number of our programs to meet this growing demand.

Specifically, the Section 202 program provides an important resource to address

the housing needs of the elderly. Along with Low Income Housing Tax Credits, the

HOME program, and Section 8/PRAC Assistance, the Section 202 program contributes significant funding toward providing affordable housing units, many with supportive services. The elderly are well-served by HUD programs with representation

that is, in general, proportionally higher than the elderly share of total eligible

households. The Department has forged successful partnerships with States, localities, and other interested parties to provide additional resources to these projects.

More than 375,000 units have been funded since the inception of the Section 202

program, which was established by the Housing Act of 1959.

The program has undergone at least two significant changes since its inception.

It began as a low-interest rate loan program without rental subsidy in 1959. In

1974, it became a loan program with project-based Section 8 rental assistance. Finally, in 1991, Section 202 became a capital advance program with project rental

assistance, and it remains so to this day. Under the current program, the capital

advance is provided without interest and does not have to be paid back as long as

the housing remains available for the intended population for 40 years. Projects developed under the current program provide supportive services dependent on the

needs of the residents.

More than 6,000 new units have been funded under the Section 202 program annually. These housing units are sponsored by nonprofit organizations, many of

which are faith-based. These organizations have a history of serving the elderly and

are committed to meeting the needs of this very vulnerable population for the 40-

year term of the project and beyond.

To make it easier to develop these projects, the Department has initiated grants

to cover certain predevelopment costs that are incurred when constructing a Section

202 project. In the past, we found that many project sponsors have spent valuable

time to cover these costs after they obtain a Section 202 commitment from the Department.

The Administration is dedicated to the ongoing viability of the Section 202 program. We are committed to working with Congress, with the nonprofit organizations

that sponsor these important projects, and with the elderly persons who are eligible

to reside within them.

The Department has experienced an increase in requests to use our multifamily

mortgage insurance programs for elderly only housing. In addressing this need, the

Department amended the MAP guide to include the Section 231 program; this

should enable the Department to process Section 231 applications in about half the

time it currently takes.

Aging in Place

HUD’s commitment to the Section 202 program goes beyond building housing for

the elderly; we also want to ensure that they have the services they need in order

to live comfortably. For that reason, the Department continues to encourage and

fund assisted-living conversion and service coordinator grants to assist existing

projects. These programs recognize that residents in our facilities are ‘‘aging in

place,’’ a concept that HUD supports by encouraging independent living, and helping

individuals stay in their homes—keeping them in their communities and close to

family and friends.

This is exactly what seniors tell us they want; 95 percent of those over the age

of 75 say they want to live independently as long as possible.

37

The Department has implemented the Assisted Living Conversion Program for 5

years. Under it, HUD provides the funds to convert existing affordable housing

units into affordable assisted-living units. HUD requires the sponsor to provide evidence that they have commitments from other sources to fund the services required

by residents. We believe that this is the only national program dedicated to the development of assisted-living facilities for very low-income households. The program

has successfully produced over 2,100 units; based on our experience, however, we

believe many more units could have been developed if the Federal response had

been better coordinated.

The Department commitment to providing the service component that is unique

to senior housing is demonstrated by our continued support of the Service Coordinator program. It is so important to us that we have an indicator in our Annual

Performance Plan to assess HUD’s ability to increase by 10 percent the number of

elderly households living in private assisted-housing developments served by a service coordinator. The Department continues to be committed to renewing expiring

Section 8 contracts and Project Rental Assistance Contracts. We understand this is

a critical component in providing affordable housing to the elderly, and we attempt

to ensure the timeliness of the payments.

Another example of interagency coordination is our collaboration with the DHHS

on the implementation of the new Medicare prescription drug coverage. We are joining forces with DHHS in educating people with Medicare—America’s seniors and

people with disabilities—that they are all eligible for this new prescription drug coverage and that there is extra help for those with low income. To accomplish this,

DHUD will train our Rental Housing Integrity Improvement Program (RHIIP) help

desk officers so they can include this new coverage in their work with the senior

citizens residing in low-income housing. We will work collaboratively and leverage

our resources to ensure that we educate America’s seniors on this new benefit.

This Administration has recognized the importance of addressing both the housing and servicing needs of the elderly, and has made these issues a priority. The

Department agrees with the Committee that seniors require a wide array of housing

options with access to services, including meals, transportation, health care, and assistance in daily activities. We also agree there are numerous Federal programs that

assist seniors and their families in meeting these needs, and that these programs

originate in many governmental agencies on the Federal, State, and local levels.

Federal Partnerships Assist in Meeting Seniors’ Needs

The Department has made efforts to coordinate to the greatest extent possible

with other agencies on its programs. But there can always be improved communication and coordination among all the stakeholders to ensure that seniors have access

to decent, safe, and sanitary housing and can obtain the necessary supportive services.

Examining the Legislation Before the Committee to Create an

Interagency Council, and How It Will Help to Meet the Housing

and Service Needs of Seniors

It is our understanding that the legislation proposes an Interagency Council similar in structure to the Congressionally mandated Interagency Council on Homelessness. The Department is a member of the Interagency Council on Homelessness,

and we have found it to be an invaluable tool in promoting a more cost-effective

Federal response to homelessness. The proposed legislation is of significant interest

to the Department. If we are indeed able to inspire effective cooperation among

those Federal agencies that address the housing needs of seniors, the effort may

yield long-term care savings that could pay for home-based alternatives. Such responses could, however, create demand for or increased spending in other programs.

The comprehensive nature of interagency work on these issues should allow for consideration of all such issues.

We believe the legislation before you today puts forth some good ideas. Thus, the

Administration supports the concept of creating an Interagency Council to coordinate the Federal Government’s efforts to address the unique needs of this continually evolving population. There are some technical aspects the Administration

would like to work with Congress to address. We question whether it is necessary

to exempt council staff from civil service provisions.

In summary, the Administration and the Department are committed to working

with Congress and our industry partners to address the growing need for affordable

elderly housing and the necessary supportive services. The proposed legislation will

provide an opportunity for us to work with other governmental agencies and stakeholders, and coordinate on a more comprehensive basis the resources required to address this growing need.

38

PREPARED STATEMENT NELDA BARNETT

MEMBER, BOARD OF DIRECTORS, AARP

JUNE 16, 2005

Good morning. Chairman Shelby, Ranking Member Sarbanes and Members of the

Committee, thank you for this opportunity to testify today, on behalf of AARP, regarding the state of housing and housing-related services for American seniors. My

name is Nelda Barnett. I am from Owensboro, KY, and I am a Member of AARP’s

Board of Directors. My remarks this morning will focus on the need to improve coordination among the various agencies, levels of government, and providers of housing and related support services that older Americans require in order to age with

dignity in their own homes.

It goes without saying that housing is a critical factor in determining our quality

of life. During the 1990’s, Americans, on average, improved the quality of their

housing. But despite the progress of the 1990’s, many low-income and moderate-income, older Americans continue to experience serious housing problems—and their

numbers are growing. At the top of the list of problems are:

• Substandard conditions—there has been remarkable progress in living conditions

over the decades; however, the 2003 American Housing Survey still indicates

around 6 percent of older households living in units with moderate or severe physical problems, • a lack of affordability, and • housing that is simply not appropriate for the changing needs of older people.

AARP’s views regarding housing policy reflect the public commitment made over

half a century ago by the Housing Act of 1949, that sets the goals of ‘‘a decent home

and a suitable environment’’ for every family in America.

Our policy recommendations are framed by our concern for:

• The affordability, accessibility, and appropriateness of housing for older persons, • The impact of the supply and demand for elderly housing and supportive services

on older persons, and • How the design and maintenance of an older person’s home can impact an older

person.

AARP research consistently documents that as Americans pass through midlife—

regardless of whether they own or rent their housing—they by-and-large prefer to

remain in their homes. This fact has been consistently documented by AARP research (Fixing to Stay, 2000; Beyond 50.05, 2005). But the adaptability of housing

to the processes of ‘‘aging in place’’ presents difficult challenges for housing facilities

that have often not been designed with these life changes in mind.

Already, what we call our ‘‘old-old’’ population—those aged 85 and over—represents the fastest growing segment among older persons in our Nation. This group

is disproportionately frail, and among the most vulnerable to excessive housing cost

burdens. To be more specific, there were about 4.6 million Americans aged 85 and

older in 2002. That number is projected to increase by more than 70 percent—to

approximately 7.3 million—by 2020. Clearly, powerful demographic forces are at

work. By 2030, the number of persons aged 65 and older will increase to 20 percent

of the population and much of this growth will be driven by large increases in the

number of persons aged 75 and older.

Today, the availability of and access to supportive services varies widely. An important factor is the residential distribution patterns of older Americans. According

to AARP’s analysis of the 2003 American Housing Survey data, 74 percent of today’s

older households live outside central cities. They are dispersed across suburbs, small

towns, and rural areas. Such dispersion presents formidable challenges to the efficient delivery of supportive services such as transportation, in-home health care,

home-delivered meals, home care, and other necessary services.

Mr. Chairman, there is a deficit of affordable and appropriate housing for growing

numbers of our older Americans. The housing and healthcare services shortfall of

today will turn into the housing and healthcare services crisis of tomorrow if our

policymakers fail to anticipate and act on the arrival of baby boomers that are of

modest means.

Given the dwindling Federal resources available to address these needs, the importance of improved coordination cannot be overstated. In this light, AARP supports enactment of S. 705, the ‘‘Meeting the Housing and Service Needs of Seniors

Act of 2005,’’ is essential. As proposed, S. 705 would establish an Interagency Council to not only coordinate service delivery, but also monitor, evaluate, and recommend improvements in existing programs and services that assist seniors in

meeting their housing and service needs at the Federal, State, and local level. And,

39

1 Redfoot, D., Kochera, A., (2004). Journal of Housing for the Elderly, (Vol. 18 No. 3⁄4, p. 137).

the Council would collect and disseminate information about the needs of seniors

along with these programs and services.

AARP strongly supports enactment of S. 705. At the same time, we urge strengthened provisions to improve the extent to which Congress and the public can evaluate any of the housing and housing-related services information collected by the

Interagency Council or that is otherwise required to be provided to the relevant

Committees and the Council. We respectfully suggest that Congress may want to

require that this information be made available over the Internet and in a format

which facilitates comparative analysis and content searches. Improving the accessibility of this data would also help improve overall public confidence in these programs.

Better coordination of housing programs is needed for a variety of reasons. In

many instances, multiple program requirements and paperwork may become duplicative and burdensome. Resident eligibility requirements and means testing procedures may also be slightly different across programs. And, different methods of

establishing rent levels and defining market areas for comparison are used by different programs. Last, different housing sponsors and agencies may have different

waiting lists that can overlap for a population at need.

The need for greater coordination is particularly apparent when trying to put together the housing, health, and social services programs at all levels of government

that are critical to successfully serving persons with disabilities of all ages. Research

has shown that Federal housing programs have very efficiently, if inadvertently,

identified those who are at high risk of needing supportive services to remain independent. Analysis by AARP’s Public Policy Institute of data from the 2002 American

Communities Survey found that, compared to older homeowners, older renters in

subsidized housing were: 1

• Much older—half of the older renters in subsidized housing were 75 or older compared to just over a third of older homeowners;

• Twice as likely as older homeowners to experience physical and cognitive limitations that threaten their ability to live independently;

• More than three times as likely as older homeowners to live alone and have weak

informal supports from family; and

• Roughly three times as likely as older homeowners to be at high risk of needing

Medicaid assistance due to low incomes and high levels of disability.

Better coordination of housing, health, and social services programs would serve

a variety of purposes. Housing managers need reliable partners from health and social services agencies to serve the large and growing number of frail, older people

in their buildings. Social services agencies could benefit from the greater efficiencies

of serving concentrations of older people with supportive services needs. But the

most compelling case for better coordination comes from the lives of the older people

who need assistance—the older woman who is desperately clinging to independence

in her apartment but has no one to help her bathe or just simply get out of the

tub; the older man who is told he must move to a nursing home to get basic housekeeping services; or the older disabled resident in a nursing home who might have

been able to leave if suitable housing and services were available.

AARP actively participated in the Seniors Housing Commission whose 2002 report

called attention to many of these issues. We have supported efforts to expand the

mission of housing programs and to provide the needed tools for serving older persons with disabilities through building features that accommodate service needs,

staffing that includes trained service coordinators, and retrofitting dollars to convert

buildings to assisted living. AARP is cochairing a process, along with the National

Cooperative Bank Development Corporation, Fannie Mae, and the National Council

of State Housing Agencies, to develop recommendations on how housing finance programs could be better structured to promote affordable assisted living. While these

efforts have been important, they do not yet approach the scale of what is needed

to serve the frail older people who need help. Only a concerted effort by all agencies

at all levels of government can adequately address these needs.

Mr. Chairman, if we continue to accept poor coordination among providers of

housing and housing-related services, we will see an America with an even greater

number of underhoused, underserved older citizens and a corresponding substantial

increase in costly and premature institutionalization of older people. S. 705 is a worthy first step as we begin to address these problems. We urge its speedy enactment.

Thank you again for the opportunity to testify. I would be happy to answer any

questions you may have at this time.

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PREPARED STATEMENT OF DANA OLSON

EXECUTIVE DIRECTOR, VOLUNTEERS OF AMERICA’S LAUREL MANOR

SENIOR RESIDENCE, COLORADO SPRINGS, COLORADO

JUNE 16, 2005

Mr. Chairman, Members of the Committee, I am Dana Olson, Executive Director

of Volunteers of America’s Laurel Manor Senior Residence in Colorado Springs, Colorado and regional healthcare manager for 11 Volunteers of America senior residences in Colorado, Nevada, and California. In that capacity, I also supervised the

opening and initial operations of our senior residence in Senator Allard’s hometown

of Ft. Collins, Colorado. I have worked for 34 years in Long Term Care—about 15

of those years as a director of nursing and the rest as a nursing home administrator. Ten years of my experience in Colorado was working in a facility with a high

population of mentally ill people.

Volunteers of America is one of the Nation’s largest and most comprehensive charitable, nonprofit, spiritually based human service organizations. We provide services

that are designed locally to address specific community needs. Our common areas

of focus include caring for the elderly and people with disabilities by fostering their

independence, promoting self-sufficiency for the homeless and for others overcoming

personal crisis, and supporting troubled and at-risk children and youth. In 2004,

Volunteers of America services across the country sshould empower over 135,000

seniors to maintain a healthy, engaged quality of life through senior centers and day

programs, home repair and homemaker services, informational and referral services,

Meals-on-Wheels and group meal programs, transportation, companion services,

elder abuse protection, case management, and coordination of other community

services.

Also, Volunteers of America is one of the Nation’s leading nonprofit providers of

quality affordable housing for individuals and families in need, people with disabilities, and the elderly in over 225 communities across the country, and is a growing

provider of assisted living, skilled nursing and Alzheimer facilities for seniors with

limited resources. As a leading provider of housing and services for the elderly, Volunteers of America is an active member of the Leadership Council of Aging Organizations, the American Association of Homes and Services for the Aging, the National

Council on the Aging, the Interfaith Coalition for Long Term Care, and the Elderly

Housing Coalition.

As a spiritually based organization we draw on more than a century of experience

and the reach of a nationwide movement that is:

• Bonded by a commitment to faith, human dignity, and social justice;

• Dedicated to actively engaging volunteers in the community;

• Committed to the highest quality of service.

On behalf of our organization, I want to express our sincere appreciation for your

interest in S. 705, the Meeting the Housing and Service Needs of Seniors Act, and

concern for the needed coordinated between housing, healthcare, and supportive

services for the growing population of seniors in the United States.

The problems we face as an nonprofit human service organization and as a Nation

in attempting to provide more and better facilities to house and serve America’s seniors, especially the frail elderly, will be severely compounded by the expected rapid

growth in the Nation’s aging population in the coming decades and the lack of adequate public policy and resources to meet that growth.

In a recent study, ‘‘The State of the Nation’s Housing 2001,’’ the Joint Center for

Housing Studies of Harvard University reported that heads of households over the

age of 75 ‘‘are expected to increase by roughly 1.3 million over the decade.’’ They

go on to say, ‘‘This growth implies rising demand for housing that allows seniors

to age safely in place and for specialized facilities such as assisted living and continuing care communities.’’

The Harvard report further indicates that, of the nearly 5 million one-person

households to be added over the next decade, ‘‘almost one-third will be over the age

of 65.’’ This growth is not going to take place in the distant future, it is going to

be taking place between now and 2010, when the baby boomer generation begins

to retire in ever increasing numbers.

In their 2004 report, the Joint Center said the Nation’s 35.6 million seniors face

a ‘‘quadruple threat.’’ First, many have inadequate incomes to pay for housing; second, increased healthcare needs compete with other basic needs; third, most live in

single-family homes that require maintenance and are difficult for caregivers to

reach because of their geographic dispersion; and fourth, ‘‘many have physical limitations or cognitive impairments that must be addressed by in-home care or strucVerDate 11-MAY-2000 18:43 Nov 20, 2006 Jkt 025856 PO 00000 Frm 00044 Fmt 6621 Sfmt 6621 30792.TXT SBANK4 PsN: SBANK4
41

tural modifications. In the 2000 Census, for example, 9.5 million seniors reported

a physical disability and 3.6 million reported a mental disability.’’

All of this is corroborated by the U.S. Department of Housing and Urban Development anticipating that today’s senior population will double in size by 2030, expanding at a rate of almost 3 percent a year to almost 70 million people by that time,

with the fastest growing segment of that cohort being persons aged 85 and older.

Commensurately, the Census Bureau estimates that 20 percent of the population in

the United States will be beyond retirement age by 2030 compared with only about

13 percent today.

Clearly, as a Nation we have a problem of extraordinary scale and urgency as the

housing and social services programs and funding we have in place today will not

keep pace with this situation. Therefore, it is so important that the programs we

have in place—like the excellent Section 202 Elderly Housing Program—operate in

an efficient and expeditious manner. But its effectiveness for the future can only

be made complete by assuring the availability of coordinated healthcare and supportive services.

Because of that need, Volunteers of America believes we are at a time in our history that calls for serious debate that leads to the creation of a national long term

care policy that is inclusive of the continuum of services issues of affordable senior

housing, adult day care, homecare, assisted living, and skilled nursing facilities.

This is vitally important to persons who are frail and elderly, especially those who

participate in federally assisted or subsidized housing, who are among the most vulnerable. As they grow older in residences designed for independent living, they are

at high risk of being forced into institutional nursing home care, or alternatively

having their needs unmet.

Much of this problem is due to the fact that the delivery of services to many persons is fragmented because of multiple policymaking authorities and funding

streams; conflicting regulations; and poorly coordinated, overlapping State and Federal Government agencies. This fragmentation is not only costly, it often times leads

to serious gaps in providing what is needed. For instance: Providers of long-term

housing finance typically to not understand the terminology or analytic framework

of the health care community. Health care regulators are unaware of the requirements of housing finance. The need to get participation and approvals for transportation, social service, and other regulatory bodies further complicates the discussion.

Housing sponsors often must spend inordinate amounts of time and energy as a gobetween because different disciplines give different meanings to important words.

Often terms like ‘‘assisted living’’ acquire precise regulatory meanings that differ

from State to State.

It is because of this existing fragmentation that passage of S. 705, the Meeting

the Housing and Service Needs of Seniors Act, is so important as a step in the right

direction to better coordination of housing programs and related services so seniors

can age in place and have access to needed services.

Let me tell you a little about my experiences in Colorado. As an Administrator

of a skilled, long-term care center, I am seeing older, more frail, acutely ill seniors

coming to us for care and rehabilitation to allow them to return home or to a lesser

level of care in the continuum. As the people we care for come to us much more

acutely ill, and the regulations under which we operate become more and more

stringent, the fragmented system is more difficult to work with. We never want to

be in a position that limits the services we need to provide to give our residents

the highest quality of service possible, but we need your help to do so.

As the Regional Housing Manager of five 202 Senior Housing Complexes in Colorado, we have a waiting list of over 200 seniors. That means 200 seniors are out

there in need of our services and we are unable to meet those needs at this time.

This only reinforces the need for more available housing with services for our seniors. The best way to meet this need is to have adequate funding to build additional

senior residences with a service coordinator in each facility. The coordinator would

have the capability of assisting our seniors access the system to fill the need for

food, medical care, and other supportive services. But even good service coordinators

have difficulty unraveling the myriad rules, regulations, agency sources, and funding streams that are intended to serve senior citizens. Passing this legislation and

establishing a Federal Interagency Council on Meeting the Housing and Service

Needs of Seniors would provide a structure for Federal agencies to jointly review

housing and service programs, more effectively coordinate Federal programs and

services, and work with States to coordinate programs and services at the State and

local level.

Adult children of middle and lower incomes, whose parents face these housing and

health care needs, are ill equipped both in terms of care management skills and financial capacity to meet all of the needs their parents face. Our Nation has evolved

42

to a point where these elders cannot look entirely to their adult children for financial and care support, since most of our households have the adults working full

time to meet their own financial obligations and the needs of their young children.

Where once upon a time in our Nation, long-term care meant providing for aging

adults in their adult children’s homes, we now by necessity have our adult children

working long days at jobs that leave little time for adult care. Somehow and in some

way the solution to this senior housing and long-term care crisis must come from

a comprehensive policy that cost-effectively integrates housing, healthcare, and supportive services for seniors into a reasonable approach that meets the needs and affordability of the individual and his/her family in partnership with State and national governments.

Some individuals might think that committed and competent providers like Volunteers of America have access to sufficient resources to meet the growing national

need for elderly housing, healthcare, and supportive services. Unfortunately, that is

not the case, especially with respect to the growing needs of frail seniors who are

not affluent. There has been a trend toward reduced funding for the development

of new federally assisted housing for seniors, the devolution of Federal housing programs to State and local governments, short-term renewals and funding for Section

8 contracts, the potential loss of affordable housing units to market-rate housing

through Mark To Market, and, more recently, cutbacks in Medicaid funding and

barely level funding for the important Service Coordinator program.

For the sake of our Nation and its deserving senior citizens we must find an efficient, well coordinated means of providing long-term care through integrated

healthcare with supportive services and housing, and that process has to begin at

the top. That is why Volunteers of America believes that the Meeting the Housing

and Service Needs of Seniors Act must be passed as a bipartisan testimony to the

worth of our older generations.

We appreciate the opportunity to bring you our ideas and perspectives and want

to assure all the Members of the Committee that Volunteers of America is strongly

committed to helping resolve these issues before the growing demand for elderly

housing and supportive services spirals out of control. We are confident that sound

solutions can be found and implemented in a way that is fiscally responsible and

fair to all parties.

Thank you.

—————

PREPARED STATEMENT OF STEPHEN PROCTOR

PRESIDENT AND CEO, PHI RETIREMENT AND SENIOR CARE SERVICES, CAMP HILL, PA

JUNE 16, 2005

Good morning Mr. Chairman and distinguished Members of the Committee. I am

Steve Proctor, President and CEO of Presbyterian Homes, Inc., headquartered in

Camp Hill, PA, and am honored to have been asked to provide you with testimony

today on behalf of Presbyterian Homes and PANPHA—Pennsylvania’s trade association representing nonprofit senior services providers. The population we serve in

Pennsylvania is among the Nation’s oldest, and in many areas of the State, requires

more care than average. We have 15 sites statewide. Some are located in the State’s

largest urban/suburban areas. Others are located in regions that are among its most

rural.

We provide the full continuum of care for Pennsylvanians in need of chronic

care—seniors and, in some of our locations, younger residents with disabilities. Our

world class staff—2,600 strong—provide housing and services to more than 3,000

residents statewide. We are extremely proud of our dedicated service and care providers without whom, providing the highest quality of care and services would not

be possible.

I will admit that when first told about the intent of S. 705 and asked to testify,

I reacted with a degree of skepticism. Historically, proposals to initiate this type of

council have been many—and solutions coming from them few. Then I read Senator

Sarbanes’ bill, and his comments during introduction of this piece of legislation. It

is consistent with PANPHA’s strategic initiative on ‘‘Consumer Choice’’—that is,

housing and services alignment driven by consumer need, not the wishes of often

well-intentioned bureaucrats and funding agencies. We strive toward this goal because it is the how consumers wish to and deserve to receive their services.

In short, this bill makes sense. The coordination proposed in S. 705 is not only

necessary—but it is also long overdue, and will provide real enhancements in the

delivery of housing and services to the people we serve.

43

As a provider of housing and services, I thought that my time before the distinguished Members of this Committee would be best spent discussing the daily challenges that the maze of statutory, regulatory, and funding requirements pose in

providing housing and services for that resident.

PHI is a sponsor of Stadium Place, a model for senior housing located on the site

of Memorial Stadium in Baltimore. This site currently contains HUD housing Tax

Credit housing for seniors, with market rate and homeownership developments to

follow. It also shares the site with a full service YMCA. It was developed to provide

seniors with limited incomes many of the same options available to more affluent

seniors of continuing care retirement communities. A recent editorial in the Baltimore Sun identified Stadium Place as the right model for senior housing. More importantly, many of the residents of Stadium Place describe it as the best place they

have ever lived. If you have not seen this project, I would encourage you to visit

the site.

The key to fully realizing the dream of Stadium Place and other similar senior

housing projects is the delivery of supportive services in an environment that can

best be described as fragmented. The combination of case management, coordination

of existing services, and flexible service delivery systems will enable this group of

seniors to live more healthy and active lives. The timely intervention of health and

social services will ultimately save money by helping residents of Stadium Place to

age in place.

Aging in place is what people desire, if their needs can be met. PHI has a person

in one of our senior housing projects that was admitted with her disabled husband

in 1970. Her needs have changed—but her desire to remain in her ‘‘home’’—since

1970—has not. We provide her with the care and support services necessary in this

setting, but it has become increasingly difficult to do so given the maze of regulatory

requirements and prohibitions across programs and funding streams. Without better

coordination among and across the agencies included on the proposed coordinating

council in this bill—she may soon be forced to leave her ‘‘home’’ with us.

There are many examples of the housing and service needs of seniors not matching up with inflexible regulations and program requirements. The following are two

recent illustrations in Presbyterian Homes’ experience.

The first scenario was an 80+ year-old man who lived in the community. He was

receiving funding for services through the Office of Aging’s Medicaid waiver. He was

receiving meals-on-wheels and was having someone come in to assist him on occasion. PHI staff was called by the Office on Aging to do an assessment on this man.

When they got there the following day, they discovered that he had fallen a day or

two before, but Aging did not have anyone to send out to see him, so PHI staff were

the only ones to help him. They found garbage up to their shoulders with a path

through the trailer. It was evident that the personal care services he needed had

not been provided in quite a while. He was admitted to a PHI personal care facility.

In this case, the funding and oversight that he received through the Medicaid

waiver was obviously not enough to provide him with the services that he needed

to stay in his home in a dignified manner. We frequently see families who are provided with the waiver money and then have to make the choice between food, utilities, medication, and assistance.

The problem in this situation is that, while this man could no longer stay at home

with the limited support systems available, when he was admitted to a PHI personal care facility, his funding COULDN’T follow him. He was not eligible for any

waiver funds, he was a few dollars over the limit to receive the $30/day personal

care home supplement which Pennsylvania pays, but he did not have nearly enough

the pay for the cost of care in personal care. In addition, in the community, he was

eligible for Medicaid health insurance (Access card), but once he was admitted to

personal care, he was no longer eligible because the requirements were different.

The only reason he was able to be cared for adequately was because we provided

him with benevolent care.

The second situation was an elderly woman with mental health issues (schizophrenia) who was evicted by a personal care home because she had extremely limited income. In her case, she was eventually assisted by an inpatient program. The

irony of this situation is that had she been admitted to a group home, another ‘‘community’’ setting or her own home, she would have received funding for mental

health services and transportation. If she would have been admitted to personal

care, she would have lost that funding because it is considered a medical facility

and therefore the personal care facility is responsible for those costs/services.

In both of these situations, the funding follows the setting, not the person. The

person’s needs and income did not change, just where they happened to live.

When placed in context by the challenges I just discussed as we provide housing

and services for, the activities of the council proposed in S. 705 take on even greater

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importance. The timing could not be better for this effort. In Pennsylvania, the 65+

population is projected to grow by 195,981 between now and 2015—encompassing

a full 17 percent of Pennsylvania’s population.

You will hear many ‘‘experts’’ tell you we will not feel any impact of the ‘‘Baby

Boom’’ until the mid-2020’s—that we have ample time to project, plan, and coordinate housing and services. It is true that is when the bulk of the ‘‘Baby Boomers’’

will begin hitting ‘‘care age’’, but to say that we do not need solutions in place until

then ignores the realities. In many States, including ours, the sheer volume of residents living past the age of 85 will fundamentally alter the need for coordinated

housing and services. Pennsylvania’s 85+ population will have more than doubled

between 1990 and 2010, growing to 336,407 persons—almost 3 percent of Pennsylvania’s total population. They are the highest users of the long-term care continuum—and do not have the luxury of waiting until 2020 for a solution to their

immediate care needs.

In Pennsylvania we are feeling the pinch now in a rather difficult budget negotiation at the State level on Medicaid funding for facilities. One of the major causes

of that battle, happening right now in many of your States as well, is a direct result

of the fragmentation of the programs and funding for long-term care. The provisions

in this bill that speak to developing best practices, identifying those barriers—statutory, regulatory, and fiscal—to providing seamless housing and services are our best

hope to meet the needs of this growing population.

Thank you again for the opportunity to provide this testimony. I speak for PHI,

PANPHA, and our national association AAHSA in applauding your efforts in this

bill. We look forward to help laying the groundwork for a delivery system that

makes more sense for providers and consumers alike. I would be happy to answer

any additional questions you have at this time.

—————

PREPARED STATEMENT OF WILLIAM T. SMITH, Ph.D.

CHAIR OF THE BOARD

AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING (AAHSA)

JUNE 16, 2005

Chairman Shelby, Ranking Member Sarbanes, Members of the Committee, I

would like to thank you for inviting me to appear before you today to discuss S.

705, Meeting the Housing and Services Needs of Seniors Act. I would like to talk

to you about the real world experience of providers and the seniors we serve, as well

as the opportunities that this bill presents for making service delivery and program

administration less cumbersome and more responsive.

My name is William Smith. I am Chair of the Board of the American Association

of Homes and Services for the Aging (AAHSA). The members of the American Association of Homes and Services for the Aging serve two million people every day, in

5,600 facilities across the country, through mission-driven, not-for-profit organizations dedicated to providing the services people need, when they need them, in the

place they call home.

AAHSA members offer the continuum of aging services: Assisted living residences,

continuing care retirement communities, nursing homes, home and communitybased service programs, and senior housing. AAHSA’s commitment is to create the

future of aging services through quality that people can trust. It is this commitment

that underlies our support of this legislation, its goals and increasing the effectiveness and collaboration among Federal programs that serve our seniors.

In addition to my work with AAHSA, I serve as the President and CEO of Aging

in America, a community-based organization that originated in 1852 with a mission

of providing housing for aged women, and has evolved into a full service organization employing over 550 staff that serves over 5,000 seniors annually throughout the

Bronx, New York. I know first hand how complicated and difficult it can be to work

with a patchwork of programs to create the range of housing and services necessary

to care for seniors with varying degrees of frailty and need.

In 1972, Aging in America developed a skilled nursing facility for 386 residents.

Later, we established a continuum of community-based services to undertake educational, research, and advocacy efforts designed to further enhance the lives of seniors in our community. In 1978, Aging in America converted a 90,000 squarefoot

high school into our social service agency, including a number of community-based

activities, intergenerational programs, an Alzheimer’s day care center, case management, victim assistance, and elder abuse counseling.

45

When we opened our first senior center in 1979 we served 45 hot lunches and provided recreational programming. Since then we have added two off-site senior centers and four satellite programs providing recreation, education, information and

referral, wellness programming and nutritional services to over 1,500 older New

Yorkers weekly. We deliver hundreds of meals daily through congregate lunches at

our senior centers and satellite locations. Furthermore, in order to help clients navigate the maze of Federal, State, and local programs we have developed a comprehensive case management program that provides services for over 700 elderly

New Yorkers, conducting in-home assessments, case management and authorization

for the delivery of in-home personal care, housekeeping services, and home-delivered

meals.

Aging in America also offers transportation services and last year we provided

nearly 300 seniors with 3,465 trips to medical and social service providers through

our program. Our telephone reassurance program assisted 450 seniors over the last

year. Our 17 bed temporary housing program provides respite, emergency housing,

and permanent living accommodations for people over 60 in need of a semi-protective environment. We are also opening a 120-unit rental community named Hertlin

House on Long Island, NY. This housing program is for independent seniors who

may require services over time. This property will be targeted to seniors with incomes $25,000 to $30,000 annually.

The Congressionally established Commission on Affordable Housing and Health

Faculty Needs for Seniors in the 21st Century, comprised of an expert panel of 13

of aging service professionals, looked carefully at the demographics, existing programs, the current system of service delivery and prepared recommendations for a

Congress on a necessary and thoughtful Federal aging policy. Senate Bill 705 is integral to that policy.

The demographics compiled by the Commission are staggering and highlight the

importance of leadership at the Federal level to coordinate programs and identify

opportunities for improving programs and service. Today, seniors comprise 12.4 percent of our population. That is 35 million people. By 2030, that number will have

doubled. Seventy million seniors—20 percent of our population—may be accessing

Federal programs to help meet their housing and service needs. The demand will

be unprecedented. We are faced with a monumental task and a remarkable opportunity. To delay working toward a solution will leave us all—governments, providers, and families—in a state of crisis, unprepared to meet the needs of our seniors. Such a scenario will inevitably require extra resources, while leaving more and

more of our elderly citizens to fall through the cracks due to overwhelmed, dated,

financially strapped, divergent programs.

One of the Commission’s primary recommendations was a call for the coordination

of housing and health care among departments. Frequently it is during a time of

crisis that seniors or their families are faced with, not one, but a maze of programs

in order to get the necessary services and appropriate housing. Eighteen percent of

seniors, 65 and older, almost 6 million people, who are not living in nursing homes

have difficulty performing at least one activity of daily living (ADL’s)—such as mobility, bathing, dressing, walking, eating, going to the bathroom, or one instrumental activity of daily living (IADLS)—such as preparing meals, assistance with

financial management, and taking medications.

Stable, affordable housing settings are the cornerstone of service delivery. Home

and community-based providers, such as Aging in America, serve seniors where they

are. I cannot overstate the importance of bringing services to all housing settings,

among all income levels. In 2020, among those seniors that will need assistance

with at least one ADL or IADL will be 5.8 million homeowners, 1.5 million unsubsidized renters and 595,000 with some form of rental assistance. Of those seniors

that own their homes, 44 percent have incomes of less than $25,000 per year and

a significant portion are facing excessive housing costs and have homes that are not

accessible and that require capital repairs. In addition to family and informal support networks, these seniors rely heavily on Federal programs. They face a multitude of needs, with varying resources, and will be significantly helped by Federal

agencies that work together.

While the Federal and State governments did not set out to create a complicated,

contradictory, sometimes duplicative system of programs and funding mechanisms

for serving those that are the most in need, that is, unfortunately, what we have.

Over several decades Congress has enacted various laws, establishing several programs, each with their own eligibility criteria, funding mechanism and regulations.

All of these programs were created with the best intentions, to meet a real, critical

need. They addressed insular problems, with little awareness or regard of other

agencies and departments working with the same population.

46

Today, over half of our senior population is over 75 years old. We—the housing

and service providers and Congress—have some experience with how older, frail

seniors utilize housing and services programs. We know that the elderly do not experience their different needs in isolation—rather they experience them in what is

all too often an overwhelming crisis that leaves them with unmet or underserved

housing, health, or service needs. Too often the result is premature, publicly funded,

costly institutionalization. With a comprehensive, coordinated system of Federal programs these seniors could be served in the most efficient manner, with programs

based on need and not driven by outdated delivery mechanisms.

The Members of Congress are essentially problem solvers and so you must be

thinking what we in the field are thinking—knowing what we know about existing

programs, current problems, growing need, and diminishing resources—there has to

be a better way to make sure that seniors can get the housing and services that

they need. Senate Bill 705 is a significant step in that direction. This landmark legislation is the necessary next step to the Commission recommendation of coordinating programs by starting with a ‘‘common vocabulary, common age for eligibility,

common definition of eligible populations, and standards for programs.’’ Most importantly it will make coordination a Federal priority and give agencies an opportunity

to identify barriers and weaknesses and refine programs to make sure that housing

and service programs work together. Senate Bill 705 establishes the perfect mechanism by which Federal programs can be streamlined with Federal policy objectives

in mind.

Across the country there have been State efforts to coordinate programs with

some success. However, it is clear that the Federal dictates that govern the programs still need work. Successes at the State level are limited because the authority

to change, modify, update regulations exists here in DC at the headquarters for

HUD, CMS, VA, Labor, Transportation, and others. Senate bill 705 will guarantee

that the Secretaries, or their designees, address and examine their programs in a

new light, with common goals of coordination, efficiency, and service.

Chairman Shelby, Members of the Committee, I want to thank you for your time

this morning. I would like to thank Senator Sarbanes for introducing legislation to

take this first step in preparing for the dramatic increase in the number of seniors

that we will see win the next two to three decades. As the head of an organization

providing a multitude of services for the elderly, I can assure you this legislation

is sorely needed to help our seniors, their families, caregivers, and providers in making sure that departments work collaboratively and purposefully toward a federally

integrated system of housing and services.

—————

PREPARED STATEMENT OF TERRY ALLTON

VICE PRESIDENT OF SUPPORT SERVICES, NATIONAL CHURCH RESIDENCES

JUNE 16, 2005

Good Morning Chairman Shelby, Ranking Member Sarbanes, and Members of the

Committee. My name is Terry Allton and I am the Vice President of Support Services at National Church Residences, a nonprofit housing, services, and healthcare

provider, based in Columbus, Ohio. National Church Residences has been dedicated

to providing quality housing and supportive services at affordable prices to low and

moderate-income seniors since 1961. NCR has over 225 communities throughout the

United States and Puerto Rico, housing more than 15,000 low-income elderly, families and persons with disabilities. As a member of the aging and not-for-profit community we feel that it is our responsibility to share our experiences and input in

the formation of public policy affecting those that we serve. I am excited to be here

to talk to you about housing, supportive services and the need for Senate Bill 705.

National Church Residence’s Department of Support Services is nationally recognized as a leader in the housing industry and our Quality Assurance program has

won national awards as the most comprehensive program of its kind in the country.

Our belief in the benefits of community-based services and supportive housing is

demonstrated by our commitment to attempt to place service coordinators in 100

percent of our facilities. In the early 1990’s, Congress enacted the Cranston-Gonzalez Act which authorized the service coordinator program. There have been appropriations since 1991 through HUD. This launched a profession with the sole purpose

of addressing quality of life issues for the elderly offering possible options to age in

place.

Our goal is to link residents with services that will allow them to remain independent, in their own homes and avoid premature institutionalization. We use a vaVerDate 11-MAY-2000 18:43 Nov 20, 2006 Jkt 025856 PO 00000 Frm 00050 Fmt 6621 Sfmt 6621 30792.TXT SBANK4 PsN: SBANK4
47

riety of funding sources to pay for service coordination, including HUD funding and

private grants. The primary function of a service coordinator is to work with service

delivery systems, provide resource information, identify programs, and assist seniors

through the labyrinth of regulations attributable to a multitude of government agencies. Our elderly residents typically do not know who supplies which services or that

some services even exist.

National Church Residences is a founding organization of the American Association of Service Coordinators (AASC), a national, nonprofit organization representing

more than 1,500 professional service coordinators who serve more than 400,000 lowincome older persons and other special populations living in federally assisted and

public housing facilities nationwide. Like others on this panel, NCR is an active

member of AAHSA and its State affiliate, the Association of Ohio Philanthropic

Homes, Housing and Services for the Aging (AOPHA). I am also here representing

AASC as the current Chair of their Board of Directors. AASC has long urged that

housing, health care, and other Federal support programs serving the elderly join

together to better focus Federal policy and regulatory efforts, in conjunction with

States and communities. Senate Bill 705 will do just that.

Before I talk about our service coordinator program, I would like to talk to about

NCR’s commitment to the preservation of affordable housing and serving residents

as they age in place. NCR has long advocated for Congress to recognize the importance of preserving existing affordable housing and helping residents at risk of losing their housing as providers ‘‘opt-out’’ of HUD programs and sell or convert their

properties to market rate. We are losing more senior housing than we are building.

To date, more than 15,000 units of federally assisted senior units have been converted to market rents. According to GAO 20 of the 41 older Section 202 properties

that will reach the end of their mortgage commitments by 2013, do not have rental

assistance. This means that those seniors will be in a precarious position to meet

their housing and service needs at a time when Federal, State, and local communities will have experienced several years of tight budgets and housing and services

are so fragmented.

Housing and services go hand-in-hand for seniors aging in place. One without the

other spells disaster for residents as they become frailer, with limited options and

few resources. Service coordinators serve as a lifeline for seniors in all manner of

housing settings and have become increasingly important part of our older senior

housing communities, where people have lived for over 20 years, aging in place. For

individual residents, service coordinators do on the local level, or at best try to do

what this legislation would do at the Federal level by coordinating, what is frequently referred to as the ‘‘crazy quilt’’ of health, housing, and service programs utilized by seniors.

Service coordinators identify resident needs, work within the community to locate

resources, provide limited case management, and organize health and wellness programs. Service coordinators also arrange homemaker services, transportation, and

meals assistance. They offer one-on-one help for residents by providing intensive assistance with entitlement and benefit programs, insurance, Medicare, and Medicaid.

Service coordinators act as a broker for services that are difficult to obtain through

public resources and assist residents in securing the help that they need to live safely and independently through community agencies. Their role not only enhances

quality of life issues faced by elders and their families, but may also influence the

cost of caring for elders by keeping them in noninstitutional care longer.

The first stage of providing a continuum of housing and service choices for the

elderly is in-home supportive services. Individuals with ample resources, many

times, have easier access and a greater variety of choices in how and from whom

services are acquired. Those living on a fixed income are more reliant on publicly

funded services, governed by Federal departments and regulations that are frequently overburdened, financially restrictive, and severely limited, and often unable

to meet the demands placed on the existing system. In addition, navigating through

a system of segmented service providers and benefits is often difficult for older persons and their families. Service coordinators are the interagency council in action.

Their lives and jobs will be made a lot easier by Senate Bill 705—not to mention

what it will mean to seniors and family caregivers who may be unfamiliar with the

aging services field.

NCR’s Support Services Division has gone to great lengths to quantify the benefits

of service coordinators. We continually monitor programs, offer training and track

outcomes. We produce tools, such as a monthly report, a semi-annual report, and

resident and manager surveys. NCR provides quality assurance to service coordinators working at 249 communities providing services to approximately 21,875 residents. Each service coordinator serves an average 87.9 residents. Over 28 percent

of the residents are 80 years of age or older and over 38 percent are considered

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‘‘frail’’ or ‘‘at-risk’’, meaning they need assistance with 1–3 or more activities of daily

living (ADL’s) per day. A recent study performed by NCR found that service coordinator time is allocated accordingly:

• Advocacy to service agencies, management, and vendors on behalf of the residents: 16 percent;

• Helping residents with Benefits and Entitlements: 13.7 percent;

• Case management: 9.5 percent;

• Monitoring services: 8.6 percent;

• Referrals to Health Care Services: 6.4 percent;

• Conducting Assessments: 5.5 percent.

It is a testament to the benefit of service coordinators in housing settings that

only 3.2 percent of their time is spent on crisis intervention.

In addition to navigating services, service coordinators help elderly residents take

advantage of cost saving program opportunities, such as prescription drug discounts,

phone bills, utility bills, supplemental insurance, medical equipment, and food. Seventy percent (70 percent) of our residents received two or more interventions by our

service coordinators that resulted in cost savings of an average $2,944.40 per year

per resident. Imagine how difficult it is for a senior living alone without access to

a service coordinator.

Service coordinators also provide a cost saving benefit to our subsidized housing

communities, by preventing unnecessary vacancies. The average cost for a vacancy

in one of NCR’s facilities is $1,732. Service coordinators help residents avoid potential eviction, undesired move-outs, and unnecessary placement at a higher, more

costly level of care. In one study, we were able to establish that service coordinators

in NCR facilities saved the properties an average of $2,393 per property over a 4-

month period by making it possible for residents to remain in their homes, aging

in place. One study shows that housing with home health care services costs approximately $60.00/day, while one day in assisted living costs $100/day, and a day

in a skilled care facility costs $180/day. The cost-savings of in-home supportive services is staggering.

A preventative, expansive, affordable range of community-based services is essential to making our communities, our staffs, and our residents successful, but more

can be done. The types of programs that our seniors rely on often come from Federal

departments and agencies or state programs that are federally funded. From Transportation to HUD to CMS, we work with a staggering number of regulations and

eligibility requirements. Under Senator Sarbanes’ bill, the primary people responsible for all of these programs will be brought to the table. This bill will give leaders

a chance to look at these programs with a bird’s eye view in the context of senior

housing, services, and long-term care. We in the industry have a number of ideas

on how to make programs work better together. It would be far more beneficial to

bring these issues to those that set and implement the policies that govern the programs.

Too often we spend time going from agency to agency and writing various headquarters offices, trying to make programs work together in order to meet our resident’s needs. We have made some headway and the State and local agencies are

eager to help, but the simple fact is that it is unnecessarily time consuming for us,

and for the agency and department staff. I urge you to consider the benefits to establishing an interagency council and to support Senate Bill 705. Federal, State,

and local governments are struggling with soaring costs related to caring for our

seniors. This legislation will give the Federal Government and our policymakers an

opportunity to create a workable solution to cost effective, noninstitutionalized longterm care—housing and services.

Chairman Shelby, Ranking Member Sarbanes, Members of the Committee, thank

you for your time and consideration of this important piece of legislation. The Meeting the Housing and Services Needs Act is the first step in maximizing program effectiveness, addressing the need for Federal coordination of programs and most importantly, serving seniors where they are—in their homes. I urge you to act on this

legislation before we face a system that is ill-prepared to serve the numbers of seniors in the future. Our Federal programs serve a very real need, a need that will

continue to grow. Unfortunately, sometimes it seems that change takes a while with

complicated programs. We cannot afford to wait. The commitment of the departments and agencies at the Federal level can make this work. Again, on behalf of

NCR, our staff and residents, thank you for your time and work on important issue.

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PREPARED STATEMENT OF STEVE PROTULIS

EXECUTIVE DIRECTOR AND VICE PRESIDENT

ELDERLY HOUSING DEVELOPMENT AND OPERATIONS CORPORATION (EHDOC)

JUNE 16, 2005

Mr. Chairman, and Members of the Senate Committee on Banking, Housing, and

Urban Affairs, my name is Steve Protulis, Executive Director of the Elderly Housing

Development and Operations Corporation (EHDOC), a nonprofit development and

management corporation based in Ft. Lauderdale, FL devoted to providing the best

suitable and affordable housing for low and moderate income older persons. EHDOC

currently has 42 senior housing facilities in 14 States, DC, and Puerto Rico for approximately 4,000 senior citizens; and has three additional properties under development. Most of our senior housing facilities are financed through the Section 202

program.

First of all, I would like to express my appreciation to you, Senator Shelby, for

your leadership in convening this very timely hearing on S. 705, legislation to establish the Interagency Council on Meeting the Housing and Service Needs of Seniors.

I am pleased that my State’s Senator, Mel Martinez is a Member of this Committee.

Not only because he is a compassionate person with practical housing experiences,

but he also has a unique perspective of the need for interagency collaboration as

the former Secretary of HUD.

I would like to start my testimony by telling a story of Marie, a frail, older resident who had lived for 14 years in one of our four senior housing communities in

southern Florida. She called our service coordinator crying because she had no other

family members or friends to help her and she did not want to go to a nursing home

as her doctor indicated that she would. Her level of frailty and income qualified her

for Medicaid. The service coordinator linked her with a community agency that specializes in a comprehensive health care program for frail elderly—a Program of AllInclusive Care for the Elderly (PACE). As a result of the collaboration between the

senior housing and the Florida PACE Centers, the resident who was previously atrisk of going to a nursing home, could continue to live in our senior housing facility,

attend the PACE healthcare center and receive needed assistance 7 days a week,

which achieved Marie’s choice to remain in her home with dignity and independence.

This is just one example of the mutual benefits of collaboration between housing,

services, and health care that enables an older person to achieve their choice to age

in place, while at the same time saving public funds. There are countless other stories in EHDOC’s properties, and the other organizations testifying today, of frail

older persons struggling to age in place. My testimony today will focus on some of

EHDOC’s experiences as well as my observations as one of the 14 members of the

Congressional appointed Seniors Commission on Affordable Housing and Health Facility Needs for Seniors in the 21st Century. The final report, ‘‘A Quiet Crisis in

America’’, was presented to this Committee on June 27, 2002.

Seniors Commission

I would like to publicly thank Senator Paul Sarbanes for the honor of being his

appointee to the Seniors Commission and for his leadership with introducing S. 705,

Meeting the Housing and Service Needs of Seniors Act As may be evident by the

attendance of many older residents from Council House, an EHDOC community of

160 units in nearby Marlow Heights, Maryland, Senator Sarbanes has earned much

respect and admiration for being a champion for senior citizens.

As we discuss today the issues outlined in Senator Shelby’s invitation letter regarding housing and service needs of seniors, and how these programs can be better

coordinated, we must always be mindful of the faces behind the data, and involve

older persons in our deliberations. One of the most gratifying experiences of the

Seniors Commission was the opportunity to hear compelling testimony directly from

senior citizens at each of our field hearings held around the country.

The one consistent message that was repeatedly heard by the Seniors Commission

from seniors, as well as from policymakers and other professional experts, was the

desire of seniors to age in place. It is appropriate that one of the key objectives of

the proposed Interagency Council on Meeting the Housing and Service Needs of

Seniors is to facilitate the aging in place of seniors, as well as to improve coordination between housing and services.

The findings and demographic information highlighted in Section 2 of the S. 705,

and the fact sheet provided for these hearings provide forceful data to justify the

need to establish the Interagency Council. These findings identified in the bill, are

reinforced by the extensive research and documentation by the Seniors Commission,

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including a thorough analysis of projected housing and services needs provided in

the appendix. The Commission reported that 53 million Americans (one in six) will

be aged 65 and older in 2020, which will represent 20 percent of the population

(compared to 12.4 percent when the report was issued in 2002). That significant increase and the need for Americans to prepare for the changing demographics represent a ‘‘Quiet Crisis is America’’ which is the apt title of the final report from the

Senior Commission.

A substantial number of older residents in federally assisted housing are women

living alone with some physical or cognitive limitations. The Seniors Commission reported that about a third of residents over the age of 65 require some assistance.

For those aged 75 and older, this rose to 36 percent and 11 percent with mental

disability that seriously interfered with their everyday activities. However, for the

lowest income of the group, with income under 150 percent of poverty level, they

are especially vulnerable with almost 214,000 or over 42 percent having at least one

limitation with activities of daily living. The average age nationally of low-income

residents of Section 202 elderly housing in 1999 was 75.

While these national figures may be helpful for public policy, for operations it is

vital that the data be considered at the community and facility level where the data

is far more meaningful. Nationally, the average age of residents in EHDOC facilities

is 79 and increasing annually; we have facilities where the average age is 80 (Florida). The desire of older persons to age in place is certainly reflective of the number

of years that they remain in federally assisted housing. Many of EHDOC residents

have lived at properties in many States including Florida, Illinois, and Pennsylvania

for over 20 years—from the time the senior housing facility was first opened. A few

months ago, one of our residents in Ohio celebrated her 101st birthday—centurions

are becoming more frequent. She has a regular exercise routine and participates in

the weekly exercise class offered at our property—that is aging in place. At one of

our properties in New Hampshire, 50 percent of the residents are over the age of

85, including one 98 years of age.

As documented by the Seniors Commission, the need for supportive services is reflected by the number of persons who are considered frail or at risk. In Florida, for

example, of our 620 units in four facilities, 37 percent of the residents are considered frail and 41 percent are at risk. This translates to approximately 78 percent

of the residents needing supportive services. In Pennsylvania, of the 348 units in

five buildings, 22 percent of residents are rated as frail and 29 percent at risk; or

over half of all residents needing services to maintain their independent living.

When considering the types of services that older residents of federally assisted

senior housing need, (based on a survey of a small sample of facilities in Florida),

the Seniors Commission reported that two of the top three most important services

related to transportation. The need to collaborate between senior housing and transportation might be of interest to the Housing and Transportation Subcommittee.

Seniors stated that transportation to and from doctor’s office (15 percent), and for

grocery shopping (14 percent) was a priority need. When asked if they had a problem getting affordable transportation to places (not within walking distance), over

25 percent of the elderly indicated that they had a problem always or most of the

time and 15 percent some of the time. The number one service need reported was

physical modifications to the facility or their apartment, that is, hand-rails, grabbars in bathrooms. Over a third reported that they had no person that they could

rely upon for their health and disability-related problems, and 16 percent said they

only had someone they could rely upon occasionally.

Dr. Stephen Golant, University of Florida, a senior issues specialist who conducted for the Seniors Commission an extensive research paper on demographics

and future housing needs of older americans (included in the Appendix of the final

report), is presenting a paper to the Commonwealth Fund and AcademyHealth

Forum next month. As he will be reporting on emerging relationships between senior housing and long-term care, when informal care giving assistance becomes inadequate, lower-income, older adults must turn to public sector solutions. (This is

when), they are likely to confront administrative or organizational barriers that

make it difficult for them to bundle together the benefits and services they need to

age in place successfully.

Dr. Golant’s report also advises that not having access or knowledge of services,

lack of funds, and the time and inconvenience it takes to secure services are important drawbacks in getting seniors the help they need. In addition, the qualifications/

eligibility may be different for each service. The paperwork alone can deter a person

from seeking the services they need.

Clearly, as often testified before the Seniors Commission, there are a number of

existing barriers that are making it very difficult for some older persons, their caregivers, professional staff, and others to assist older residents to access a range of

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supportive services. The Seniors Commission identified a number of major barriers

to linking housing and services, including the traditional distinct roles of various

Federal departments, such as HUD, focusing on a safe, decent, and affordable place

to live, that is, to provide a roof over seniors heads—but not to provide the types

of services essential for enabling aging in place and/or quality of life for older residents.

Some of these barriers are the types of actions that can be addressed by the proposed Interagency Council on Housing and Service Needs of Seniors. For example,

the Commission identified a number of administrative and organizational barriers

caused by different government programs, levels of government, different types of

providers (public, private, or nonprofit), different funding streams. As characterized

in the final report, . . . ‘‘housing and service needs of seniors traditionally have

been addressed in different ‘worlds’ that often fail to recognize or communicate with

each other . . . while policymakers have struggled to be to be responsive to the

needs of seniors, the very structure of Congressional Committee and Federal Agencies often makes it difficult to address complex needs in a comprehensive and coordinated fashion. For example: Medical needs of seniors are addressed by Medicare

and Medicaid; social services needs are address by Medicaid, the OAA (Older Americans Act), and other block grant programs; housing programs are administered by

HUD and the Department of Agriculture’s Rural Housing Services (RHS); and

transportation programs are administered by the U.S. Department of Transportation.’’

Future of the Interagency Council on Housing and Service Needs for

Seniors

I believe that the various functions identified in Section 5 of S. 705 for the Interagency Council will significantly contribute to forging better communication and collaboration between the various Federal agencies (as identified in Section 4c of the

bill) involved with housing, services and health care, as well as between the Federal

Government with State and local governments and with the private sector. For example, the Council could examine ways to promote increased collaboration by making more compatible the different income eligibility to participate in some HUD and

HHS programs. HUD and USDA/RHS could collaborate with the Department of

Health and Human Services/Center for Medicare and Medicaid Services (HHS/CMS)

in working with States and local communities to ensure suitable and affordable

housing is available in communities seeking to develop Home and CommunityBased Services either in response to the Supreme Court, Olmstead Decision requiring community options for persons with disabilities or as part of the Administration’s New Freedom Initiative. The Interagency Council could facilitate a means to

implement the various recommendations of the Seniors Commission: To provide a

means to streamline counterproductive regulations; to compile and exchange data,

research, and technologies; or a ‘‘one-stop-shop’’ for best practices or to foster the

development of innovative or cross-cutting models. As the Commission reported, ‘‘the

Nation can no longer afford the inefficiency of the current disconnect between housing and health services systems for seniors.’’ The time has come for coordination

among Federal, State , and local agencies and administrators. The establishment of

the Interagency Council could help improve efficiency among the various Federal

agencies within the existing structure.

While some could argue that the benefit of the Interagency Council is saving

costs—and perhaps even could be self-financed by recycling cost savings, I believe

that the focus of this effort should not be saving money, but rather on saving lives.

Remember my first story of Marie, the frail, older lady in Florida who was able to

remain in her home through effective collaboration between the housing provider

and the health care provider? The Interagency Council could help promote the replication of models like this as a means to save the life of another older person in

another facility (or own home). The Program for All-Inclusive Care for the Elderly

(PACE) program is administered by States and funded through Medicaid and Medicare for a wide range of health care and services, but does not have HHS funds for

the physical structure to house a PACE center. Some federally assisted and public

housing may have a number of frail residents who could benefit from the PACE program, but do not have HUD funds nor desire to operate the PACE program. However, if there should be surplus space in or adjacent to the housing facility to enable

the colocation of a PACE center, it is a win-win situation for the frail elderly, the

housing provider, the PACE provider and taxpayers. The Interagency Council could

help expedite the development of both the PACE and Center space as well as transportation through uses of more flexibility with existing funds.

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Service Coordinators

One of the key recommendations of the Seniors Commission for forging increased

collaboration between senior housing and services is the staffing of service coordinators. I am pleased that Terry Allton is here to testify on behalf of the American Association of Service Coordinators (AASC) where I am honored to serve on the Board.

I am pleased that EHDOC has a service coordinator for nearly all of our 42 properties. In our website: www.ehdoc.org we include a copy of our Newsletter, New Dimensions, that includes a Service Coordinator Page with quarterly examples of

exemplary efforts of service coordinators assisting seniors to age in place. The following are two examples where our service coordinators have not only assisted vulnerable frail elderly to remain in their home as they desired, but also saved public

funds.

Council House, Marlow Heights, MD—One of our residents, Edna, stopped socializing as much as she used to. She had such severe leg pain that even using a walker

was not possible. She seemed to be slipping into a depression because she was confined to her apartment. The Service Coordinator suggested that we get her a wheelchair, but she said that she would not be able to push herself around because she

is too weak in her upper body.

The Service Coordinator told her about another option that could work. We contacted a company that has motorized, compact scooters. We ordered one and Medicare paid for it. Edna now ‘‘drives’’ herself everywhere. She is much happier now

that she can again go outside, come down to bingo, come down to lunch where she

plays cards with friends, attend religious services, etc. Her fear was that she would

become so immobilized that she would have to move to a nursing home.

By keeping this resident mobile so she could live at home, we saved Medicare over $10,000 the State of Maryland nearly $40,000 plus additional savings with other

Government programs and significantly reduced costs to the low-income, older person. These estimates are based on the average cost of nursing homes in Maryland

over the 2 years that Edna has been able to continue to live at Council House since

getting the scooter.

Mildred and Claude Pepper Towers, Miami, FL—Our service coordinator has

helped link our frail residents into the State’s Channeling program to enable them

to continue to live independently in their apartments. For example, the program has

helped one of our resident’s, Fannie, by providing a visiting nurse and home health

aide to conduct daily cleaning activities, medications ands home delivered meals,

thus saving the government tens of thousands in the 2 years that she has been in

the program. Before Fannie was linked with this program, she thought she would

have to go into a nursing home.

Despite the ample documentation of the cost effectiveness of service coordinators

in enabling frail elderly to access community services, it may require an investment

in one department (HUD) to save money in another (HHS). Unfortunately, funding

for service coordinators in Federally assisted senior housing, as well as with public

housing, is woefully inadequate to ensure that facilities providing affordable housing

for low and moderate income elderly have sufficient resources to include service coordinators as part of the operating budget of federally assisted and public housing.

The Interagency Council could facilitate actions that both agencies would find mutually beneficial, including interagency training, access to timely information, technologies, or best practices.

Private Sector Collaboration

One of the issues that Chairman Shelby asked us to address was the role of the

private sector with housing and services needs of seniors. Rightfully so, considering

that senior housing and services is big business: Jobs, consumer products, taxes, etc.

Senior housing and services has a symbiotic partnership with the private sector.

The Seniors Commission examined a number of issues that need the active involvement of the private sector with housing and services, including increased role for

Government Sponsored Enterprises (Fannie Mae, Freddie Mac), bonds, and various

tax incentives. With the present rapidly escalating housing costs and tight local

markets, many federally funded facilities that could be used for affordable senior

housing are being lost through conversions to condos.

Given the demographics, the limited Federal funding for Section 202 and other

affordable senior housing, and long waiting list for most facilities (nationwide

EHDOC has over 4,200 seniors waiting for affordable housing—more than those

who currently resident in our facilities), we need to create additional means to finance the development and preservation of affordable senior housing. Some existing

buildings could be acquired through public-private partnership, rehabilitated, add

enhanced services, and reposition in the community as mixed-financed, mixed-use,

and mixed-income senior housing, as part of a community long-term care strategy.

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We clearly need effective interagency collaboration with the GSE’s, HUD, IRS, State

housing finance agencies, banks, State and local government, and the private sector.

EHDOC could not function without partnering with the private sector. For example, we have been successful in work with Homeward Bound to provide 100 hours

of free personal care aids to residents in New York; Verizon Corporation, BellSouth,

and SBC for donations in excess of $100,000 in computers for seniors to be connected to today’s technology, and the Pequot Indians Prescription Drug Program

which provides prescription medication to EHDOC seniors at the lowest possible

costs.

In addition to the efforts of our service coordinators brokering linkages between

senior residents with a myriad of public and private community agencies, EHDOC

has established a program to promote collaboration between our residents, our facility, and the local community. Our Community Action Program (CAP) is designed to

encourage active participation between seniors and their community. We promote

volunteers both by our resident’s involvement within the community, as well as by

community organizations and individuals to assist our residents. Again, our website

provides an on-gong listing of local programs in our newsletter. One of the recent

examples of CAP which we take much pride, was action taken by our residents in

response to the devastation caused by the Tsunami. Our low-income, older residents

conducted bake sales and other fund raising activities (some with local private sector matches), and were able to raise and donate $25,000 to survivors. Not only

would an Interagency Council be helpful with our local, State, or national efforts

by exchanging timely information nationwide, but now also worldwide. I will be discussing our CAP program in Norway next week as part of the International Association of Homes and Services for the Aging (IAHSA).

One final comment on the private sector and S. 705 to establish the Interagency

Council on Meeting the Housing and Service Needs of Seniors, I would like to suggest that we borrow a phrase by the Nike Corporation . . . ‘‘Just Do It!’’ I believe

that the establishment of the Interagency Council is the next step building upon the

wealth of testimonies, research, data, best practices, and countless hours of deliberations of the Seniors Commission. It was the wisdom of the Congress in establishing

the Seniors Commission to give us an 18-months deadline. I believe that the final

report provides ample justification for the need to increase interagency and public

and private collaboration in meeting the housing and services needs of rapidly increasing elderly population. While it was challenging, we met the deadline, and delivered our final report and recommendations to this Committee at hearings held

on June 27, 2002 before Senator Sarbanes and the Banking, Housing, and Urban

Affairs Committee. I am pleased that the Committee arranged for the final report,

as well as the proceeding of the hearings and related actions to be available at

www.seniorscommission.gov. I would like to request that the Committee take additional actions to ensure the extensive demographic research paper is also inserted

into the website. I am pleased that the Commission was identified as a contributing

factor in the introduction of this important and timely legislation. I am encouraged

that the establishment of the Interagency Council on Meeting the Housing and

Service Needs of Seniors will provide a means to address and implement its comprehensive list of recommendations.

My final comment would be to think like Nike of the private sector: ‘‘Just Do It!

At EHDOC we have modified this phrase to: ‘‘Feel It (in your heart), Think it (do

your homework), and Do it (take timely actions). I would urge your quick passage

of this bill to establish the Interagency Council on Meeting the Housing and Service

Needs for Seniors; and urge your support to ensure its quick enactment during this

109th Congress. Thank you.

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RESPONSE TO A WRITTEN QUESTION OF SENATOR STABENOW

FROM ALPHONSO JACKSON

Q.1. In the LEGACY Act of the American Dream Downpayment

Act of 2003, what is the status of: The provision to create a demonstration program to train employees in the rights of

intergenerational families in connection with the Section 202 Supportive Housing for the Elderly program; the provision that Census

study be done in relation to HUD Section 202 housing?

A.1. The LEGACY Act provisions of the American Dream Downpayment Act authorized the Department to carry out a demonstration program to provide assistance for intergenerational dwelling

units for intergenerational families in connection with the Section

202 Supportive Housing for the Elderly program. The Act was

signed into law on December 16, 2003. However, the Consolidated

Appropriations Act of 2004 (Public Law 108–199, approved on January 23, 2004) did not provide an appropriated amount to carry out

the demonstration units. The fiscal year 2005 appropriations bill

again did not provide funds for this purpose. Although funds are

not yet available to carry out the demonstration, the Act also included a provision that directed the Department and the Bureau of

the Census to conduct a study to determine an estimate of the

number of grandparent-headed and relative-headed families in the

United States and their affordable housing needs. The study is expected to be completed this summer.

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