Statement of Jack Balinsky, Chair, NYS Council of Catholic Charities
to the Commission on Affordable Housing and
Health Facility Needs for Seniors in the 21st Century
July 30, 2001 Syracuse, New York

Congressman Walsh, members of the Commission, distinguished guests, thank you for the opportunity to testify today. I am Jack Balinsky, Executive Director of Catholic Charities in the Diocese of Rochester and Chair of the New York State Council of Catholic Charities Directors. The Council is an advisory committee to the New York State Catholic Conference, which speaks for the eight dioceses of New York State on matters of public policy. My comments today are on behalf of the Catholic Conference.

The Catholic Conference participates in the development of policy at the state and federal level, to address issues such as access to affordable housing, health care, and services to aging persons. Our positions are not developed in response to a political agenda or ideology; instead, we draw from the richness of Catholic social teaching and the experiences of Catholic parishes and institutions. Every day, Catholic programs touch thousands of lives, as we provide services to children, families and seniors, in fulfilling our ministry to those among us. I will now address the issues raised by the Commission, in light of the Catholic experience.

Today's hearing is to allow the Commission to achieve its goal of investigating and providing recommendations to the Congress on how to shape the housing and services needs for our elders today and into the future. From the perspective of the Catholic Church, this is an issue that is not solely related to housing programs nor to health care services. There is an emerging recognition that successful aging occurs along a continuum, from independent living in one's home to institutional care. This Commission can play an important role in helping to shift our focus toward a continuum of care, responsive to the needs of individuals, rather than the current categorical imperative that drives and limits flexibility and innovation.

In November 1999, the U.S. Department of Housing and Urban Development released the report Housing Our Elders¹, which noted that America's seniors are among the best-housed citizens in a nation of good housing, but cautioned that many lives in housing that costs too much, is in substandard condition or fails to accommodate their physical capabilities or needs for assistance. They summarized traditional challenges in senior housing as 1) adequacy, 2) affordability and 3) accessibility, but noted that a fourth dimension, appropriateness, has emerged. This fourth factor addresses the need for flexible housing solutions that combine assistive services with housing, to provide maximum choice to aging citizens.

The Catholic Church operates many skilled nursing facilities, assisted living facilities, home health care, and other daytime programs where dignified, compassionate care provides living witness to our mission. These programs serve the elderly and other vulnerable individuals with specialized programs, including Alzheimer's care, pain management and palliative care. We also develop and manage housing programs that provide shelter and supportive services, including counseling, case management, and social programs, to seniors and others with special needs. Our ministry is delivered by caring staff and volunteers, who witness their faith and the dignity of human life-including the aging process-by serving those with special needs.

Housing programs must embrace both the health care and social services ministries, recognizing the role of each in helping aging individuals and those with special needs to live in the least-restrictive setting. We believe that all persons should have a safe and decent home, but we pay special attention to the needs of low-income, frail and other vulnerable persons. Most importantly, our services are based on beliefs and values that are grounded in centuries of Catholic social teaching, including:

Holistic care which identifies and meets the physical, emotional, social, and spiritual needs of the person;
Respect for life and the inherent dignity of all persons, recognizing that we are created in the image and likeness of God;
Responsiveness to the community and individual needs within a geographic or specialized area;
Responsible stewardship of limited resources; and
Fulfilling the ministries of the Church and maintaining our Catholic identity.

My comments today will draw upon the Catholic mission and values in order to address particular areas of concern, including: developing affordable housing, especially in rural areas; providing supportive services to allow seniors to stay in the least-restrictive setting; and addressing the need for affordable assisted living options for lower- to middle-income seniors.

More than 25 years ago, the Catholic Bishops of the United States issued the statement The Right to a Decent Home: A Pastoral Response to the Crisis in Housing,² which addressed a severe housing crisis at a vastly different economic time than we face today. You will remember that in the 1970s, our nation went through period of economic inflation and recession, driving the cost of housing out of reach for many lower income families. Today, we are at the end of the longest peacetime expansion of the American economy and, unfortunately, millions of American families and elderly still lack decent housing. The Bishops' assessment of the problems and the solutions, however, have not changed-any attempt to provide a decent home for all Americans must address the complicated interchange of economic, political, and social factors.

The Congress has supported the development of housing for elderly and vulnerable populations through capital investment, such as the Section 202 program and Section 8 vouchers, as well as the creation and management of public housing facilities. Experience has shown that there are strengths and weaknesses to each model, but it would appear that Section 202 projects garner the most support from the political, economic and social sectors. In fact, Catholic Charities USA has met recently with HUD to propose a demonstration program that uses the 202 model to create new housing for low-income families in the Archdiocese of Chicago. Yet, this is not an either-or choice, so Congress must invest sufficient funds to maintain and replenish the existing assisted housing stock while increasing funding for new development.

According to the National Low Income Housing Coalition³ , HUD's current budgetary authority is one-third of the level in 1976, while overall federal spending has almost doubled. While we do not advocate a blanket return to the policies and programs of 25 years ago, we believe that reductions in HUD funding reflect a decision to abandon housing development primarily to the free market. The Bishops noted in 1975 that decent housing is a human right and its provision involves a public responsibility, including a creative partnership of private enterprise and government. We must not forget that the federal government provides indirect housing subsidies through personal income tax deductions for home ownership; there must be similar government investments in direct housing programs to ensure a decent home for all. This is particularly important for the elderly and disabled, who have limited incomes yet face rising expenses for property taxes, medical care including prescription drugs, and housing maintenance costs.

The Section 202, or Elderly Housing Program, was established by the Congress in 1959 and modified several times, but it remains the primary federal program for financing the construction of subsidized rental housing for the elderly. Since 1990, Section 202 facilities have been authorized to hire professional service coordinators to assist in the delivery of services to residents with complex social, medical and economic needs. Section 202 units may provide congregate meals or housekeeping services, personal care, social work/counseling services, or transportation for medical or social activities. According to the American Association of Retired Persons, 41.6% of all 202 projects nationwide are sponsored by religious communities, with an equal number sponsored by "other" nonprofit groups.⁴ This was a reduction from the 49.7% religious sponsorship reported in 1988, but the study's authors suggest that the reduction could be due to the addition of the "other" category or the increased use of professional management services in religious-sponsored entities. Regardless, religious communities are still a significant factor in the development of 202 housing.

The Catholic Church in New York State operate housing units for the elderly in seven of the eight dioceses; there are none in the Diocese of Ogdensburg, however Catholic Charities in that diocese helped organize community support for 44 units that were developed with HUD funding. Many of these programs were developed with Section 202 funding and continue to serve the low-income elderly. However, the demand for units exceeds availability. For instance, in the Diocese of Albany, 608 senior housing units are 99 percent occupied, with a 6-month waiting list. In the Diocese of Syracuse, the Christopher Community operates 1400 units on 30 sites for seniors, financed with Section 202 funding of 28 sites and NYS Tax Credits for two others. These units are 98 to 100 percent occupied and there is a two-year waiting list for new residents. In rural parts of the Syracuse Diocese, encompassing the communities of Homer, Cortland, Truxton, Marathon and Clancy , Catholic Charities operates 300 units in seven sites, with an occupancy rate of 97 percent and a waiting list of 100 individuals.

Catholic Charities in Western New York, administered by my colleague and Commission member Monsignor Henry Gugino, operates 746 housing units in 15 buildings for seniors. These were financed with a combination of Section 202 funding, and New York funds, including the Affordable Homes Program, NYS Tax Credits, Housing Trust Funds and the Homeless Housing Assistance Program. The units, which are located in inner cities as well as suburbs, are 97 percent occupied and there are waiting lists for 15 percent of the units. While Charities is able to provide case management services as part of the tenants' initial orientation, there is not sufficient funding to incorporate amenities such as beauty parlors, game rooms, elder crafts/consignment space, and private conference rooms, to meet the social needs of the residents.

In September 2000, HUD announced awards of almost $600 million in housing assistance for low-income elderly under the 202 program⁵. In New York State, some of the recipients included programs operated by the Catholic Church. However, the funding approved does not eliminate the waiting lists for senior housing. The capital advance covers the cost of developing the housing and need not be repaid if the housing is available to very low-income seniors for at least 40 years. The rent subsidy covers the difference between the residents' contribution toward the rent and the cost of operating the project. These projects are in areas that facilitate residents' participation in social activities, shopping, and health care services and may include on-site service coordinators. The Commission should recommend that Congress increase federal financial commitment to provide access to capital funding for not-for-profit developers and subsidies to residents, by building upon the 202 programs, as well as the low-income housing trust funds and other funding streams that foster the development and operation of housing for low- and middle-income seniors.

The development and operation of affordable housing also require the cooperation of local governments which establish zoning and building codes, and the provision of community services and green space. The Commission must consider the increasing use of zoning rulings and regulations to prevent the development of affordable housing in suburban communities. Housing discrimination on the basis of gender, disability, ethnicity, age or income is wrong and the Commission must send a clear message to communities affirming the goal of community integration.

Catholic Charities agencies in New York have particular concerns about the accessibility and availability of housing and other services in rural areas. In parts of the Syracuse Diocese, individuals are living in substandard housing and the aging are often forced to abandon family homes to seek other living opportunities in major population centers. In Cincinnatus, New York, religious women have been working with the State Division of Housing and Community Renewal and Cornell University to research and explore options for affordable housing. The Commission should provide support for these efforts with enhanced funding and flexibility to enable development in less-populous areas.

The development of housing and services for the aging requires the ability to meet the complex needs of individuals in a personal and caring manner. Catholic agencies view the individual in a holistic manner and attempt to meet the physical, mental, social, and spiritual needs of the person. These categories do not always meet a single funding stream for government programs, requiring the Catholic agency to combine various funding streams to develop and fund appropriate programs and services.

The United States is in the midst of an aging boom. Thanks to advances in public health and technology, more people are living into their 70s and 80s and beyond than at any other time. This new cadre of older persons is in better health, is better educated and is more affluent than at any other time in U.S. history. In spite of their improved health, however, the elderly may require assistance with activities of daily living, including housekeeping, shopping and eating. New York State provides supportive services, which are delivered by not-for-profit agencies in the senior's home. These services help seniors to maintain themselves in the community and, more importantly, continue their social, spiritual and familial relationships. Unfortunately, too often the demand for home-based services exceeds the available supply, leaving some seniors without essential services.

As seniors age and their need for supportive services increases, there are still options short of nursing home placement. Frail seniors and those with Alzheimer's might not be able to stay at home alone during the day, yet nursing home placement is not appropriate. Today working families often struggle to find affordable, quality care in the form of day programs or activities, which meet the social, physical and mental health needs of aging New Yorkers. Social Adult Day Care programs, authorized under New York State Executive Law, provide a community-based alternative for seniors who require assistance or programming during daytime hours.

The Catholic Charities Adult Day Care program has operated in Erie County since 1973, operating 5 days a week, serving an average enrollment of 65 clients. Most participants attend two days per week and 75% are 75 years of age and older. Those served are residents of Erie County, 60-plus years old; socially isolated; physically impaired or confused; and, able to participate in group activities. Participants may receive personal care, showers, meals, spiritual care, transportation, and social work services. There are opportunities to participate in music, exercise and education programs, community outings, structured recreation and intergenerational programs with the child care program downstairs. Clients are monitored for changes in health, reminded to take medications and provided special diets when ordered by their physician.

Yet, these service are funded by piecing together 16 separate public and private funding streams including: Community Services for the Elderly (CSE); Expanded In-home Services for the Elderly Program (EISEP); Title III-D of the Older Americans Act; Long-Term Home Health Care Programs; Day Habilitation contracts with the NYS Office of Mental Retardation and Developmental Disabilities; Child and Adult Care Food Program (CACFP) funding from the U.S. Department of Agriculture; Title V of the Older Americans Act, Services for Older Workers; Welfare-to-Work Programs; private fees; fund raising; and, of course, support from the Diocese of Buffalo's Catholic Appeal. The complexity of the funding demonstrates the need for the Commission to address the continuum of care, and recommend funding which meets human needs, rather than government bureaucracies and structures.

An emerging factor in the provision of home-delivered services is the nursing shortage and crisis in direct care workers. Many agencies lack sufficient staff to assess and deliver in-home services that are necessary to maintain individuals in their homes. At times, an agency can find staff to assess the client's needs, but they are not be able to deliver services, leading to false expectations, at a minimum. In the worst case, a patient's condition might deteriorate while he or she awaits in-home services and require intensive, costly in-patient services or residential placement. Catholic Charities agencies in parts of New York State have shut down home-care services, leaving large groups of vulnerable individuals without an alternative to residential care. The Commission should develop recommendations that facilitate the recruitment and retention of direct care workers, including nurses, social workers, home health aides, and others, through the use of loan forgiveness provisions and increased reimbursement rates.

Another aspect of caring for elders in the community is the role of the family caregiver. Caregivers often face high levels of personal and familial stress, as they attempt to balance the needs of a family member with other family obligations, most likely including employers. For the first time, we have seen the creation of the so-called "sandwich generation", of middle-aged Americans who must transition from caring for children to caring for parents. Support groups allow the caregiver to connect with others in similar situations and "vent" their frustrations in a safe environment. In addition to learning new coping skills the sessions provide much needed education to caregivers negotiating multiple systems in roles for which they were not prepared. In the case of Western New York services, recent caregiver satisfaction surveys indicate that 56% of respondents worried less at work and 45% can continue to work because of the safety and security our program provides. In April 2001, Governor Pataki announced that New York will receive $7.5 million to support family caregivers under the Older Americans Act⁶. These funds will finance a caregiver support program in local offices for the aging, to offer information, assistance, counseling, training and respite to individuals who provide care to frail or disabled family members. The Commission should reinforce this spending and ensure that States utilize the funds to support caregiver services, including respite.

The Commission is well aware of the demographic shift in our country as the baby boom generation ages. This is placing stress not only on the demand for services, such as health care, but also changing the setting in which services are delivered. Increasingly, the elderly are seeking an Assisted Living Program (ALP), which provides housing along with supportive services. However, the costs of housing and services are significant, so that many assisted living programs are priced out of the range of lower- and middle-income seniors. We are concerned that, as in other areas of housing and health care services, the person left behind is the middle-income, working class family. The Commission must prevent the development of a two-tiered system, one for the well-off and one for those relying on public assistance and Medicaid.

In the Diocese of Rochester, Bishop Sheen Ecumenical Housing has developed 168 unites for seniors, all of which are fully occupied with waiting lists. In addition, Bishop Sheen is adding a 31-unit second phase at an Assisted Living Senior site (Brentland Woods/Henrietta), financed by HUD section 232/IDA funding. Another project in the early development stages is Honeoye Place, with $1.7 million of Low-Income Housing Trust Fund/Housing Trust Fund financing, to provide 24 new units. It is anticipated that these new units will be filled upon completion and waiting lists will be created at the same time. The experiences of Rochester reflect the trends through the Empire State, demonstrating the need for additional federal and state funding.

A significant portion of the cost of assisted living programs is the development and operation of the property. In rural areas, the low-density population makes it difficult to achieve the minimal size necessary to achieve economies of scale. In urban areas, particularly those with high housing costs like Metropolitan New York and Long Island, the cost of land is prohibitive. In many areas, the estimated cost of land acquisition, development and maintenance would require that residents be charged $3,000 per month. This would exclude the necessary support services, including food, housekeeping, and assistance with activities of daily living, placing the residence far beyond those of moderate or low income. We urge the Commission to recommend increased Congressional funding for the development of independent and assisted living programs for seniors in all parts of New York State.

Assisted living programs in New York State and across the nation, are proliferating. Under the leadership of Commission member and colleague James Introne, New York's Governor Pataki developed legislation to address the proliferation of regulated and "look-alikes" which are not currently regulated. Although this legislation has not been approved by the State Legislature, there are aspects which we would recommend to the Commission, including the need to:

• Establish minimum standards for disclosure, fees, and services, in both marketing materials and contracts to protect the vulnerable consumer at a time of stress;
• Develop a standard assessment tool to determine the suitability of an applicant for a program;
• Clarify the maximum services and programs available in the assisted living program, and when a resident must be transferred to a more intensive level of care;
• Amend the Medicaid program to increase the services available to people with special needs, including the elderly with mental illness or developmental disabilities.

However, in the process of regulating and overseeing assisted living programs, states and the federal government must ensure flexibility regarding services offered and other arrangements. A "one-size-fits-all" approach is not helpful to either consumers nor providers.

I have addressed a range of issues in response to the Commission's interest in the housing and social health care needs of aging persons. In conclusion, it is our belief that every person has a right to decent housing. In 1999, Catholic Charities programs in New York State provided permanent housing to 10,084 individuals, and temporary shelter services to 11, 574. In addition, we provided emergency financial assistance-often for prescription drugs and to avert eviction-to 53,089 individuals and utilities assistance to another 6,471 persons⁷. Clearly, there is a housing crisis, and Catholic Charities agencies are one of several entities holding off disaster one step at a time.

It is the obligation of the Church to build awareness of the housing crisis, and to work collaboratively with government and the private sector to develop programs and services that achieve decent housing for all. Our concern, however, is not just for houses or programs, but for the people who inhabit these dwellings or are affected by these programs. The poor, the disabled and the elderly have special housing problems that must be addressed in a sensitive and particular way. We are committed to working with the Commission and other parties to reduce alienation and isolation, by providing safe, affordable housing, that allows individual to achieve their maximum human potential in community with one another.

Thank you for the opportunity to testify today. If you have any questions, I would be happy to address them at this time.

¹ Housing Our Elders, U.S. Department of Housing and Urban Development, November 1999.

² The Right to A Decent Home: A Pastoral Response to the Crisis in Housing, A Statement Issued by the Catholic Bishops of the United States, November 20, 1975.

³ Testimony of Sheila Crowley, President, National Low Income Housing Coalition to US Congress Committee on Financial Services, Subcommittee on Housing and Community Opportunity, May 3, 2001.

⁴ The 1999 National Survey of Section 202 Elderly Housing, Public Policy Institute of AARP, Washington, DC, January 2001.

⁵ HUD Awards Nearly $600 Million in Housing Assistance for Low-income Elderly, HUD No. 00-272, Washington, DC, September 28, 2000.

⁶ Governor Announces New Elder Caregiver Support Initiative, April 10, 2001.

⁷ 1999 Catholic Charities USA Annual Survey, Alexandria, VA, December 2000.