The Commission on Affordable Housing and Health Facility
Needs for Seniors in the 21st Century
September 24, 2001
Joan W. Lawrence
Ohio Department of Aging
The Ohio Department of Aging administers over $300 million in federal and state funds, serving 2 million older Ohioans and their families. Among other programs, we administer a Medicaid waiver that supports 24,000 nursing home eligible people in their own homes.
I'm happy to be here today to reinforce the idea that housing is connected to services - by default, whether we choose to connect it in our policies and programs or not: Housing conditions impact people's need for community services, and housing costs impact their ability to pay for services.
We in government must move toward policies that support consumers and their caregivers, because it means helping families help themselves. We must emphasize consumer choice, autonomy, control and self-determination. In light of the Olmstead decision two years ago, I also want to emphasize that government must address access to affordable services, particularly those that enable elders and people with disabilities to maintain their independence and live with dignity in settings they prefer.
Ohio Access was a new vision for long-term care services and supports for the elderly and people with disabilities. A two-year study, including a series of public forums, resulted in the development of a plan for the future. Governor Taft's Ohio Access Report reflects state policy, but also includes policy recommendations for Congress and the Administration, including:
- Realign spending in institutional care to match capacity with consumer demand.
- Work with existing private institutions and institutional providers to examine new ways to transition to new models of community-based care and to diversify their businesses.
- Clarify the role & responsibilities, and strengthen the accountability for local and regional entities responsible for assisting consumers and their families in accessing and coordinating services.
- Allow Consumers to choose the most integrated and least restrictive settings in which to receive services.
- Allow federal program flexibility so we can make Medicaid, housing and OAA programs work together to serve low income elderly more efficiently in the settings they choose. For example: allow States to provide targeted, affordable home & Community-based Services without a federal Medicaid waiver.
- Take measures to end the fragmentation that exists in financing for services. Funding for services for those living in supported housing environments comes from a variety of sources including Medicare, Medicaid, Older Americans Act, Social Services Block Grant, Community Mental Health Services Block Grant, Developmental Disabilities Assistance and Bill of Rights Act, as well as state and local funds. This fragmentation in funding unfortunately has created a fragmentation in services for those living in supported housing.
In general, the types of community supports needed by those living in supported housing falls into the category of long-term care. The lack of coordination between funding sources - federal, state, and local - has created great problems for consumers and for states. In part, this fragmentation is a result of an artificial division between "acute" care services, funded primarily by Medicare and "long-term care" services funded by Medicaid and other funding sources. The focus has been on shifting costs to another payer wherever possible rather than on the needs of the consumer. The National Governors Association has called upon Congress and the federal administration to address federal barriers to the timely development of case management and integrated care programs (such as PACE) across funding sources.
I also want to introduce several other recommendations that I hope will be reinforced by others throughout this hearing and future hearings, and which emphasize these concepts of access and choice. All of these recommendations involve partnerships: with federal, state and local governments, and with the private sector, but Congress and the Administration can create policies and programs that provide incentives and reduce barriers:
- Construct user-friendly buildings using principles of universal design, so residents of federally subsidized housing can function independently.
- Expand kinship care & caregiver support programs, empowering families and communities. Support provisions in the reauthorization of TANF (Temporary Assistance for Needy Families) that positively affect grandparents raising grandchildren. Cooperate with children's groups on policy issues of importance to grandparents raising grandchildren. Expand funding for caregiver support, provide technical assistance and share best practices.
- Expand service coordination for low-income renters so they can identify, choose and access needed services. Here in Ohio we are committing state funds for this purpose, and area agencies on aging are providing this service for many elderly residents. But Federal financial support, and help in defining quality standards - is vital.
- Strengthen reverse mortgage counseling for aging homeowners so they can safely tap into and use their home equity to stay in their homes. The Home Equity Conversion Mortgage (HECM) is such a good resource for older homeowners, and it's increasing in popularity:
Each year since the product became available the number of loans has grown, but this is the first year that there has been a substantial increase in closings. Lenders are reporting 25 to 75 percent increases over last year.
Reverse mortgages are quite a bit different from other types of debt. These loans can be complicated, and borrowers have a lot at stake. They need to investigate the product carefully and make difficult decisions. FHA insured reverse mortgages require borrower counseling and it is a vital component to this program. Congress and HUD can strengthen the reverse mortgage program by:
- Testing and approving individual counselors.
- Funding HECM counseling separate from other HUD counseling. This is the only kind of counseling required by federal law prior to completing a transaction, so we have extra responsibility to make sure the counseling is of high quality.
- Provide incentives for agencies to do counseling. Pay them on a per client basis, and not directly by a particular lender.
- Create a single, national equity limit - instead of the current system with a different one in each of the 3000 plus counties.
I hope that the commission, in this and future field hearings, will examine these issues and give them due attention in your report to Congress.
Thank you for your attention and consideration.