The Commission on Affordable Housing and Health Facility
Needs for Seniors in the 21st Century
January 14th, 2002
Miami-Dade Housing Agency
MR. RENE RODRIGUEZ: Thank you and good afternoon and thank you so much for allowing us to testify before such an esteemed Commission.
Of course, in Florida when we talk about elderly, we always think that we're first because, you know, we have a very large concentration. This is a retirement state and whatever happens in Florida is going to happen in the rest of the nation in five to ten years to come.
So we're really right in the front of things. So certainly any support you can provide to us pioneers is mostly welcomed.
I am the Director of the Miami-Dade Housing Agency. We run a mortgage program for home buyers. We also run 11,000 public housing units and 16,000 Section 8 units.
One of the things we found out is that just in our public housing units alone, we have a turnover in any one year of 350 to 500 elderly that vacate. Most of them end up nursing homes.
I also serve on the State Affordable Housing Study Commission and on two national boards; the Council of Large Public Housing Authority and also on the Housing Research Foundation.
A couple of years ago, I also served on the State's task force that was create by the State legislature to look at long term care. So I know a little bit, a little bit about this issue. I also have twenty-nine years of housing experience.
One of the things -- just to give you a little bit of demographics, and I do have some handouts for your benefit -- is that we're finding that through most of the Housing Authorities in the State of Florida and assisted housing through federally subsidized programs, the population continues to age.
Also, the population coming in as new tenants is also much older and literally, there's very little place for them to go.
As we look at the statistics nationally, in 1990 about 4 percent of the population were 65 and over, with about 3 million.
Today, it's about 13 percent of the population, 35 million Americans 65 and over. By the year 2020, there will be 53 million Americans 65 and over.
So whatever we're doing, certainly, you know, this issue of long term is going to continue.
Florida is the retirement capital of this great nation and certainly we're seeing that we'll be the pioneer on this.
By the year 2017 -- 2017, just fifteen years from now -- one out of every four Floridians will be 65 and over. In Dade County where you are now, we have the single largest concentration of elderly in the state of Florida.
When we look at the population growth, we also have to compare on the development side. And what we've seen through the last few years is that since 1998 the construction of senior housing has really gone down at the national level.
In 1998, there was 50,000 units for seniors under construction. In 1999, it went up to close to sixty-six.
But by year 2000, the development of new construction for elderly was down to 35,000, so we're concerned about that.
We also see that in the year 2000, the construction of elderly housing over 51 percent has some sort of assistive component to it, either assisted living or congregant living, so on and so forth.
So in that regard, I think the industry is trying to deal with the frail elderly and long term care.
When we looked at the programs to address it, we see that there's a pressing need to deal with what we see as a financial crisis coming down the pipe.
There's a lack of affordable housing alternatives to meet the demand, and many residents to not have options. Certainly, when we look at alternatives, the only alternative -- and we don't profess that this is the only solution and I'm going to be discussing that a little bit -- is we do have one assisted living facility. And I understand you've heard testimony from some of our residents at the Helen Sawyer Plaza that the savings is about a third -- the cost, actually.
I'm sorry, I apologize. The cost of operating an assisted living facility as compared to a nursing home is about a third, anywhere from a fourth to a third.
And we know a lot of our residents that are in the Helen Sawyer will be in nursing homes because a lot of them came from nursing homes so know this is a good alternative.
And this is funded through a combination of sources: Medicaid waivers, OSS, or the State supplemental and U.S. HUD through the rental subsidy, they also play a very important part.
We opened our doors in January of 1999. Sixty percent of a hundred apartment buildings now is on Medicaid waivers. Our estimated cost in those short years is $5 million. That's a savings to the state and to the federal government.
One of the things I would like to discuss with you and it was mentioned here earlier on the previous panel, some of the barriers. I think one of the biggest barriers that we have is we don't have a common definition of what is an assisted living facility.
Everybody's kind of playing by their own rules, you know. So I think it would be something very beneficial to try to establish a federal policy on what is assisted living facility.
The closest thing that we have is the ADA or the Americans with Disabilities Act and the Fair Housing Amendments Act, the FHAA. And these are very wide ranging and you would still require a lot of legal interpretation to see how assisted living may play into that.
On the development side, they're limiting funding for development of assisted living facilities. We're aware of the HUD 232 Program and the Small Tax Credit program. Those are also available.
We also are very concerned that the largest production of affordable housing today is the low income tax credit, and that prohibits Alzheimer's clients from being served under this program.
And I think that's a serious concern. Certainly, we in Florida, we see a large percentage, and I know the state of Florida is going through crisis in serving this population.
At the state level, we also look at licensing regulation and I know the issue of licensing came before here and in the state of Florida you may be surprised that there's some regulations that apply to assisted living facilities that do not apply to nursing homes.
Would you believe that nursing homes are not required to have liability insurance in the state of Florida but assisted living facilities are?
So, you know, I mean, there's a combination, and we may be unique; but certainly, I think that's something that needs to be addressed.
Also, the certificate of need process, the CON, which was mentioned earlier also needs to be addressed.
At the local policy level, the two barriers that we have are zoning issues that sometimes can be used to stop the development of an assisted living facility and fire codes.
And as a recommendation and I'm trying to be very brief and be available for your questions, I think we need to look at long term care as a continuum of care. I don't think we have a fix-all for everybody, but I think services need to be provided, too, for the family members and the individual to make choices. And I think the choices are very limited now.
And the other thing I'd like to address is the issue of Medicaid wavier because a lot of states like us are using Medicaid waivers for community-based and for assisted living facilities. And I would argue that it shouldn't be a waiver, that Medicaid should pay for those services and there should be categories for such.
Thank you very much.