Commission delivered final report to Congress on June 28, 2002
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Hearing on "The Preliminary Findings of the Commission on
Affordable Housing and Health Facility Needs for Seniors in the 21st Century."

Statement of Ellen Feingold
Co-Chair Commission on Affordable Housing and Health Facility Needs
for Seniors in the 21st Century

Thursday, June 27, 2002 Dirksen Senate Office Building Room 538

I am Ellen Feingold, Co-Chair of the Commission on Affordable Housing and Health Facility Needs of Seniors in the 21st Century and also President of Jewish Community Housing for the Elderly, a non-profit non-sectarian developer, owner and manager of over 1,000 units of government funded housing for low-income elders in the Boston area.

I want to thank the Committee and especially Chairman Sarbanes for inviting me and my Co-Chair Nancy Hooks to testify before you today. I also want to take this opportunity to thank Congressman Barney Frank who, together with Senators John Kerry and Barbara Mikulski and Congressman Alan Mollohan gave me the great honor of serving on this Commission and the opportunity to work with my fellow Commissioners towards ensuring that our nation's elders are well housed and have the health and supportive services they need as we move through the 21st century.

I come before you as someone who has dealt with the problem of providing decent supportive housing for elderly persons every day for over twenty years. JCHE's residents' average age is over 80, and their incomes average around $10,000 a year. They are very old, very poor, and increasingly frail. I know first hand how valuable the tools are that the federal government has given us to work with, and in the Commission's Report we describe the ways these tools are being used innovatively to create housing environments in which people can grow old safely, with dignity, and with the supports they need to be as independent as possible.

But we also know how inadequate the quantity of resources we have are NOW. My organization has 1,050 apartments, all occupied all the time, and 1,800 people on our waiting list at any one time. Every day, people call me and my staff, pleading for housing for themselves or their family members. Often, your staff call me and my colleagues in your states on behalf of your constituents who are frantic with worry and need. The Commission report has numbers and statistics describing what has become a crisis; but I hear the need from desperate seniors first hand, as do you. What do you tell them? I have to tell them it will take years before there will be a JCHE apartment for them. Can you imagine telling an 80-year-old that they will have to wait six years for an apartment? This need for decent, supportive, affordable housing is not an abstract issue. These are real people, our own parents and grandparents, and their need is critical and urgent.

The Commission heard this story over and over-and we heard how grateful seniors who live in government-assisted housing are for their quality affordable housing. And we heard over and over that what is needed is MORE.

The Commission is presenting to you a piece of groundbreaking research, in which Dr. Stephen Golant of the University of Florida quantified today's housing need, and projected this need in 2020. In Part III of the Commission Report, Key Findings and Projections, you will find a summary of his work, and his analysis of the need and the full report is in the Appendix. Dr. Golant found that, for every rent-assisted unit currently occupied by a senior, there are almost six seniors with housing problems-either due to affordability, or poor conditions, or other problems-who cannot access decent, affordable housing.

The Commission's Minority supports most of the Commission Report-its findings and many of its recommendations.

This Minority Report goes beyond the Majority Report in calling for greatly increased housing production goals, for using our resources first to meet the needs of the poorest and frailest seniors, for major changes in the systems for providing and funding services to seniors, and for a commitment to providing the major increase in funding that these changes will require. We believe that the only way that our nation can meet the anticipated crisis in supply is by starting NOW to meet today's huge need.

Just how great is the need? Looking at Dr. Golant's Exhibit I (Part III, page 3), you will see that there are currently 1.2 million government-subsidized rental units housing 1.3 million seniors. Exhibit 8 (Part III, page 9) shows that there are currently 6.1 million very low- and extremely low-income seniors with priority housing problems who are NOT living in those 1.2 million units. In other words, today's gap is 6.1 million units. Even assuming that only one-half or one-third or even one-quarter of those 6.1 million urgently needy very poor seniors want to live in decent rent-assisted housing, you can see we are looking at a current deficit of 1.5 million to 3 million units.

Projecting to 2020, and such projections are of course very approximate and subject to all kinds of caveats, Dr. Golant estimates there will be 9.5 million very low and extremely low income seniors with priority housing problems. Again, assuming that only one-quarter of those seniors want to live in rent-assisted housing, this means we ought to produce 2.4 million units over the next 17 years, or 140,000 units a year, if we want to be able to provide decent affordable supportive housing to the country's seniors in 2020.

Those numbers are huge! Suppose we do the same set of calculations just looking at very low- and extremely low-income renters with priority housing problems. Today, there are 2.4 million seniors in that category, NOT living in rent-assisted housing. Since they are renters, one could predict that a higher proportion of them would live in rent-assisted housing if it was available. If half of them would do so, this means today's deficit for renters is 1.2 million units.

Dr Golant estimates that in 2020 there will be 3.2 million very low- and extremely low-income renters with priority housing problems. To provide decent affordable supportive housing to half of them, we should produce 94,000 units a year between now and 2020.

It is in the context of these numbers that the Commission Minority recommends to Congress that it authorize and fund an immediate production goal for subsidized elderly housing with supportive services of at least 60,000 units a year for the foreseeable future. This housing could be developed through the highly successful Section 202 program, the Rural Housing Service's Section 515 program, public housing programs, and the low-income units in tax credit developments.

You might then ask the question: if we assume that it might take 94,000 units a year to house those very poor senior renters with unmet priority housing needs, and as many as an additional 46,000 units for very poor home owners with priority housing problems who might want to move to such housing, why recommend only 60,000 units a year? It is the Minority's view that it will take time and effort to gear up at all levels-administration, producer capacity, regulatory, etc.-to be able to utilize an authorization of even 60,000 units. This is a big jump in federal commitment-for example, this year's Section 202 authorization was for only 5,800 units, just a few hundred for Section 515, and no additional public housing units. 60,000 units will be a serious start to meeting both today's and tomorrow's needs. But less than that would indicate an avoidance, a failure of will in heading off the crisis.

The Minority also recommends major funding of at least $200 million for the Affordable Housing Preservation Act to stem the potential loss of any of the 324,000 affordable elderly housing units at risk.

With respect to the health and supportive services that seniors need to enable them to age well in place, the Minority recommends a number of short term and long term steps.

First, we make a series of recommendations that are similar to those in the Majority Report to strengthen the highly successful service coordination program in senior housing: that the HUD Service Coordinator grant program be expanded to all federally assisted low-income housing and its funding increased to a realistic level; that public housing authorities be funded to enable them to contract for services to their elderly residents; that Medicaid Home and Community Based Services waiver funds be guaranteed for supportive services in all federally assisted senior housing, including those projects utilizing the Assisted Living Conversion Program; and a number of others.

More basic, it is obvious that the current federal agency structure, in which housing and the various services seniors need are provided separately by separate government departments which are governed by separate Congressional Committees and separate OMB sections, does not lend itself to well-integrated and coordinated housing and service programs. When the Commission began its work, I thought this would be the single most important focus of our work. However, the Commission's limited time frame and mandate militated against in depth consideration of structural reorganization proposals. Instead, the Minority proposes a number of concrete steps that will begin the process of creating a coordinated system.

For example, the Minority recommends a simple change that will make eligibility determinations in HUD-funded and HHS-funded programs easier to coordinate. Currently, HUD determines program eligibility according to the regionally sensitive Area Median Income standard. HHS programs use a national standard-either the Federal Poverty Level or the Supplemental Security Income level. The Minority recommends that HHS program eligibility be based on the Area Median Income to facilitate the linking of HUD and HHS programs.

Similarly, the Minority recommends that HUD and HHS jointly develop a uniform definition of assisted living and assisted living services for seniors.

In another more ground-breaking example, the Minority recommends a new Aging in Place demonstration program that links funds provided through the HHS Home and Community Based Service waivers and other Federal senior supportive service programs (through AoA and DOT, for example), with HUD and RHS rent subsidies to support aging-in-place strategies for frail residents.

These are small steps that can perhaps lead to far greater linkages among the programs that help support successful aging.

And finally, recognizing that the principal payment systems for services and health care for seniors are the Medicare and Medicaid programs, the Minority offers two recommendations that will begin the transformation of these programs for the 21st century.

First, we join the call for a Medicare Prescription Drug benefit. The new wonder drugs available today have made possible declining hospital utilization rates as more and more serious conditions can be treated out of the hospital. But seniors often cannot afford these drugs and therefore wind up requiring the far more expensive hospital care. The Prescription Drug Benefit has become an essential prong of a comprehensive and cost-effective health policy. Likewise, the success of today's health care measures is evident in keeping seniors alive and relatively well-functioning for many years longer, but brings with it a need for home care for the resulting chronic conditions and disabilities. Again, without necessary home care, seniors will wind up in much more expensive hospital care. The Minority therefore recommends an expansion of Medicare coverage to include chronic and long-term care and prescription drugs.

Similarly, the relatively complete coverage that Medicaid provides to low-income seniors does not require that home and community based services be provided on an equal basis with institutional care and other Medicaid entitlements. Since Medicaid is a joint Federal-State program within which States have wide latitude in designing their program, there has been a reluctance to impose a new entitlement on States. The Minority believes that putting home and community based services on an equal footing with institutional care will, in the long run, save money, as it will avoid the far more expensive institutional care. More important, it will respect the dignity and choice of seniors who wish to remain in their own homes as long as possible. It will also enable states to respond positively to the mandate of the Supreme Court's Olmstead decision that individuals have the right to choose to live in the least restrictive environment that will meet their needs.

The Minority also stresses the importance of adequate training and pay scales for the workers who provide services to seniors and we provide a series of recommendations to improve their working conditions.

In closing, you gave the Commission an enormous mandate, to look ahead at a problem that is clearly and dramatically growing in scope. The Minority believes that denial and wishful thinking have no place in trying to solve a problem. We believe that members of Congress asked to know the scope of the problem and the hard realities of its solution. The country's unprecedented success that makes possible many more years of life for the elderly of our country than were even dreamed about just a generation ago has created an unprecedented demand for housing and health and supportive services. The hard reality is that there are unprecedented costs involved in meeting this demand.

This country has the resources to pay these costs. The country uses them according to our priorities and our commitments. We have used our resources with extraordinary success to create the highest rate of homeownership in the developed world by permitting the interest we pay on home mortgages to be tax deductible-a subsidy amounting to $60 to $90 billion in 1999. We must now begin to bring parity in resource allocation to the housing and service needs of low-income elders that we brought to stimulating homeownership.

The Minority urges Congress to commit the Nation once again to assuring a good old age for its seniors who have contributed so much.

The effort of this Commission, both Majority and Minority members, has been to provide Congress with information and with new tools to address the crisis ahead. We have participated in a nationwide dialogue which we have reported to you. It is our hope that the outcome will result in better health and greater independence for the huge numbers of elderly people who will surely need both.

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