Endnotes
1. Title V, Section 525(b) of the Departments of
Veterans Affairs and Housing and Urban Development, and Independent Agencies,
Act of 2000, Public Law 106-74, October 20, 1999.
2. "A Profile of Older Americans: 2001," Administration
on Aging, U.S. Department of Health and Human Services, Administration on Aging
(2001).
3. Stephen M. Golant, Ph.D., “The Housing Problems of
the Future Elderly Population,” a Report Prepared for the Commission on
Affordable Housing and Health Facility Needs for Seniors in the 21st
Century, January 2002. Table 18.
4. Golant, Figures 42-47.
5. Golant, Table 17.
6. Leonard Huemann, Winter-Nelson, and James R.
Anderson, “The 1999 National Survey of Section 202 Elderly Housing,” Washington,
DC: Public Policy Institute of the American Association of Retired Persons,
2001.
7. Michael Bodaken, "Preserving and Improving
Subsidized Rental Housing Stock Serving Older Persons: Recommendations to the
Commission on Affordable Housing and Health Facility Needs for Seniors in the
21st Century," National Housing Trust (2002), 8.
8. "The State of the Nation's Housing 2001," Harvard
Joint Center for Housing Studies, (2001), 29.
9. Golant, Table 8. Based on projections using
1999 AHS data.
10. "State of the Nation's Housing: 2001," 29.
11. "The Lewin Group Projections from the 1996 Survey of
Income and Program Participation, Wave 5," prepared for the Commission on
Affordable Housing and Health Facility Needs for Seniors in the 21st
Century, 2002.
12. See: Ada Helen-Bayer, Leon Harper, "Fixing to
Stay: A National Survey on Housing and Home Modification Issues," AARP,
(2000).
13. See: Cushing Dolbeare, "Changing Priorities, The
Federal Budget and Housing Assistance 1976-2006," (May 2001). Washington
DC: National Low-Income Housing Coalition.
14. A Profile of Older Americans 2001 AOA
http://www.aoa.gov/aoa/STATS/profile/2001/1.html:
"Since 1900, the percentage of Americans 65+ has more
than tripled (4.1% in 1900 to 12.4% in 2000), and the number has increased
eleven times (from 3.1 million to 35.0 million). The older population
itself is getting older. In 2000, the 65-74 age group (18.4 million) was eight
times larger than in 1900, but the 75-84 group (12.4 million) was 16 times
larger and the 85+ group (4.2 million) was 34 times larger."
15. See: Cushing Dolbeare, "Changing Priorities, The
Federal Budget and Housing Assistance 1976-2006," (May 2001). Washington
DC: National Low-Income Housing Coalition.
16. Dr. Stephen Golant of the University of Florida at
Gainesville compiled much of the data presented here for the Commission.
Dr. Golant's report can be found in Appendix G-1 of this
report. In addition to data compilation, Dr. Golant did original
analysis of the 1999 American Housing Survey.
17. Administration on Aging, "A Profile of Older
Americans: 2001," Washington, DC: U.S. Department of Health and Human
Services, Administration on Aging (2001).
18. Golant, Table 18.
19. Golant, Figures 42-47.
20. Golant, Table 17.
21. Figure refers to vacancies in existing units.
22. Huemann, et.al, “The 1999 National Survey of Section
202 Elderly Housing,” Washington, DC: Public Policy Institute of the American
Association of Retired Persons, 2001.
23. Michael Bodaken, "Preserving and Improving Subsidized
Rental Housing Stock Serving Older Persons: Recommendations to the Commission on
Affordable Housing and Health Facility Needs for Seniors in the 21st
Century," Washington, DC: National Housing Trust (2002), 8.
24. "The State of the Nation's Housing 2001," Harvard
Joint Center for Housing Studies, (2001), 29.
25. Golant, Table 8. Based on projections using
1999 AHS data.
26. "State of the Nation's Housing: 2001," 29.
27. "The Lewin Group Projections from the 1996 Survey of
Income and Program Participation, Wave 5," prepared for the Commission on
Affordable Housing and Health Facility Needs for Seniors in the 21st
Century, 2002.
28. See: Ada Helen-Bayer, Leon Harper, "Fixing to
Stay: A National Survey on Housing and Home Modification Issues," AARP,
(2000).
29. Golant, Table 17. The Commission finds a
requirement of 730,000 new units to be added to either the 1.2 million number
found in the American Housing Survey or the 1.7 million found in subsequent
studies, including: Andrew Kochera "A Summary of Federal Rental Housing
Programs, Fact Sheet #85" AARP, (2001), 4. The basis for the difference in
the two studies results from the age used in each study (i.e. 65+ in the Golant
study and 62+ in AARP Fact Sheet study).
30. When speaking of current or “today’s” housing
arrangements, the document is normally referring to conditions in 1999.
31. Golant, Table 1. See also:
American Housing Survey for the United States: 1999" Table 7-12, 416.
32. Golant, Figure 36.
33. Federal Register, Vol. 67, No. 31, February 14, 2002,
pp. 6931-6933. Different guidelines exist for Alaska and Hawaii. SSI
limits are available from CMS.
http://www.hcfa.gov/medicaid/ssi0102.htm.
34. Enid Kassner, Lee Shirey, "Medicaid Financial
Eligibility for Older People: State Variations in Access to Home and
Community-Based Waiver and Nursing Home Services," AARP, (2000) 7-8.
35. Only about 10% of rent-assisted households have incomes exceeding 50% AMI, Golant, Figure 36.
36. For a more detailed exposition of these data, see Appendix G-2.
37. For example, for Boston, MA, 50% of median annual income for a single person in 2002 is $25,950, while 300% SSI is $19,620.
38. A 1999 HUD report estimated that the average waiting list for affordable rental housing was 33 months. Although this data is not senior specific, it is a broad indicator
of the length of time that eligible persons go unserved. See:" U.S.
Department of Housing and Urban Development, "Waiting in Vain: An Update on
America's Rental Housing Crisis Washington, DC: U.S. Department of Housing
and Urban Development (1999).
39. Although most seniors qualify for Medicare, the program does not provide the
long-term care services offered by Medicaid.
40. Golant, Table
1.
41. Golant, Figure
40.
42. Golant, Figures
40-48.
43. “State of the
Nation's Housing 2001," 29.
44. Housing costs for
renters include contract rent, utilities, property insurance, and mobile home
park fees. Housing costs for owners include payments for mortgages or
installment loans or contracts, real estate taxes, property insurance, homeowner
association fees, cooperative or condominium fees, and utilities. Dwelling costs
do not, however, include costs for maintenance and repairs.
45. HUD Reports refer to this category as “other
problems.”
46. Households with negative or zero income are not
considered as housing cost burdened. Housing costs are compared with the
household’s income from the previous year. Households that reported their
monthly costs as 100% or more of their past year’s income were included in the
“serious cost burden” category.
47. See: American Housing Survey, 1999, Appendix
D.
48. American Housing Survey, 1999, Table 7-12, lines
64-66.
49. Those receiving rent assistance are excluded from
the analysis.
50. Based on U.S. Census population projections and
Harvard household projections.
51. Projections are the exclusive work of Dr. Stephan
Golant, the Commission's demographic consultant.
52. American Senior Housing Association, "Senior
Housing: Solving America's Long-Term Care Crisis" (1999), 2. According to
the report, 82 % of senior homeowners own their homes outright. If this
trend continues, many senior homeowners will have a valuable asset to leverage
to meet their needs.
53. For a discussion of the challenges of remaining in
one's own home, see: Kathryn Lawler, "Coordinating Housing and Health Care
Provision for America's Growing Elderly Population," Cambridge, MA: Joint Center
for Housing Studies, Harvard University, (2001).
54. Timothy Waidmann, Kenneth G. Manton, "International
Evidence on Disability Trends among the Elderly." Washington, DC:
Department of Health and Human Services, Assistant Secretary for Planning and
Evaluation, Office of Disability, Aging, and Long-Term Care Policy (1998).
Many studies such as the one cited indicate that while the total population of
seniors is increasing, the percent of disabled seniors among them is
decreasing. The aggregate number of disabled seniors is increasing at a
rate slower than the overall population of disabled seniors.
55. "Projections of the Resident Population by Age, Sex,
Race, and Hispanic Origin: 1999 to 2100," U.S. Census Bureau, Population
Projections Program. (NP-D1-A) (2000).
56. The model has two major components: 1) the Pension
and Retirement Income Simulation Model (PRISM), which projects work and
family history, retirement income, disability, and nursing home use; and 2) the
Long-Term Care Financing Model, which projects home care use, long-term care
financing and policy simulations.
57. Data sets can be found in Appendix G-1.
58. As discussed earlier, the general maximum
eligibility for Medicaid is 300% of SSI, which is roughly about 220% FPL.
59. In 2002, the FPL for an individual in the
continental United States was $8,860,250% of which would be $22,150.
Source: Federal Register, Vol. 67, No. 31, February 14, 2002, pp.
6931-6933.
60. Robert Mollica, "Personal Care Services: A
Comparison of Four States," (2001) 1. See also: Normandy Brangan "The
Medicare Program," AARP, (2001).
61. National Investment Conference. 2001. The Case
for Investing in Seniors Housing and Long-term Care Properties. Annapolis,
Maryland: National Investment Conference for the Senior Housing & Care
Industries.
62. Evidence does not exist that the assisted living
alternative will become less expensive over the next two decades (National
Center for Assisted Living. 2001. Facts and Trends: The Assisted Living
Sourcebook 2001. Washington, DC: National Center for Assisted Living,
American Health Care Association.)
63. In the third quarter of 2001, the mean assisted
living occupancy rate was 85.5% (Robert Kramer, in an address to the national
conference of the National Investment Center in Washington), December 13, 2001.
In 1999, the mean occupancy rate was 89.4%.
64. The first three assumptions underlie the nursing
home projections of The Lewin Group for the Commission on Affordable Housing and
Health Facility Needs for Seniors in the 21st Century.
65. U.S. Census Bureau, Population Projections Program.
2000. (NP-D1-A) Projections of the Resident Population by Age, Sex, Race, and
Hispanic Origin, 1999 to 2100. Washington, DC: U.S. Census Bureau,
Department of Commerce.
66. Consistent with earlier tabulations, this report is
primarily interested in the demand for assisted living units rather than the
existing or future supply of assisted living units. For any given year or
period, the supply of assisted living units must be reduced by its occupancy
rate and the percentage of units occupied by seniors as opposed to
non-seniors.
67. The first three assumptions underlie the nursing
home projections of The Lewin Group for the Commission on Affordable Housing and
Health Facility Needs for Seniors in the 21st Century.
68. U.S. Census Bureau, Population Projections Program,
2000.
69. National Investment Conference. 2001. The Case
for Investing in Seniors Housing and Long-term Care Properties. Annapolis,
Maryland: National Investment Conference for the Senior Housing & Care
Industries.
70. These estimates are expressed in persons rather than
units. Thus, they should be somewhat larger than this report’s projections
for that reason alone.
71. See: Cushing Dolbeare, "Changing Priorities, The
Federal Budget and Housing Assistance 1976-2006," Washington DC: National
Low-Income Housing Coalition (May 2001).
72. Robyn I. Stone, “Long-Term Care for the Elderly with
Disabilities: Current Policy, Emerging Trends, and Implications for the
Twenty-First Century,” Milbank Memorial Fund, 2000.
73. 12 U.S.C. 73 Stat. 654, 667.
74. Huemann, et. al, “The 1999 National Survey of
Section 202 Elderly Housing,” Washington, DC: Public Policy Institute of the
American Association of Retired Persons, 2001.
75. Housing Research Foundation.
76. Abt Associates (Finkel and Buron), “A Study on
Section 8 Voucher Success Rates.” Vol. 1: Quantitative Study of Success
Rates in Metropolitan Areas. Prepared for U.S. HUD, November 2001.
77. National Council of State Housing Agencies,
“State HFA Factbook: 2000 Annual Survey Results.”
78. NCSHA.
79. Testimony by Sue M. Harris-Green, Deputy Director,
Multi-Family Housing, Direct Loans, Rural Housing Service, U.S. Department of
Agriculture, Baltimore, Maryland, 3/11/2002.
80. HUD Website.
81. H.R. 5640, passed December 5, 2000.
82. In 2001, waiver programs in 49 States and the
District of Columbia served more than 560,000 individuals. Arizona is the only
State that does not use the 1915(c) waiver because it provides comparable
services under another demonstration waiver authority.
83. Excerpted from the HCFA report: Nursing Home
Transition Grant 2000, May 2000.
84. CMS website.
85. HHS-AoA Website.
86. HHS-AoA Website.
87. "Senior Housing Construction Report," American
Senior Housing Association, 2002.
88. “The Consumers’ Directory of Continuing Care
Retirement Communities,” 1999-2000, American Association of Homes and
Services for the Aging, 1999.
89. “Federal Housing Assistance: Comparing the
Characteristics and Costs of Housing Programs”, GAO-02-76 Washington, DC:
Government Accounting Office, Jan. 2002.
90. Lifecycle cost is the total cost of owning,
operating, and maintaining a property over its useful life. In this
analysis, GAO assumed a useful life of 30 years.
91. David Smith, Recapitalization Advisors, Boston,
MA.
92. Susan Coronel, “Long-Term Care Insurance in
1998-1999,” Washington, DC: Health Insurance Association of America,
2002.
93. Michael Bodaken , “Preserving and Improving
Subsidized Rental Housing Stock Serving Older Persons: Recommendations to the
Commission on Affordable Housing and Health Facility Needs for the
21st Century.” March 1, 2002, p. 2. (Appendix G-3 in this
report.
94. Bodaken, Tab 3.
95. Bodaken.
96. Ability to refinance is defined any Section
236-insured property with rents at or below market (<=110 percent FMR) and
other non-236 properties with interest rates of 9 percent.
97. Prior to 1990, Section 202 financing was available to
developers of housing for both elderly and disabled, low-income households. This
report focuses only on those properties that are for seniors, and therefore, the
total number of units will be less than the number of units for the Section 202
program as a whole.
98. Other Section 8 is defined as any Section 8-assisted
property that is not insured under the Section 202, Section 236 or Section
221(d)(3) BMIR programs. Some of these properties may not have a HUD-insured
mortgage.
99. Housing Research Foundation, Public Housing for
Seniors: Past Present and Future, Washington D.C.; 2002.
100. Housing Research Foundation, Public Housing for
Seniors, 2002.
101. Testimony to the Commission by Thomas W. Slemmer,
President, National Church Residences, Columbus, Ohio, September 24,
2001.
102. Golant, Table 1.
103. Golant, see footnote 3.
104. Housing Programs of New York State 2002, New York
State Department of Housing and Community Renewal, (2002).
105. Testimony to Commission by Dr. Jon Pynoos, Associate
Professor of Gerontology, Ethel Percy Andrus Gerontology Center. San
Diego, California, Hearings, November 7, 2001.
106. Many types of structures are built in the factory and designed for
long-term residential use. In the case of manufactured and modular homes, units
are built in a factory, transported to the site, and installed. In panelized and
pre-cut homes, essentially flat subassemblies (factory-built panels or
factory-cut building materials) are transported to the site and assembled. The
different types of factory-built housing can be summarized as follows: Manufactured Homes: Manufactured homes may be single- or multi-section
and are transported to the site and installed.
Modular Homes: These factory-built homes are built to the State,
local, or regional code where the home will be located. Modules are transported
to the site and installed.
Panelized Homes: These are factory-built homes in which panels - a
whole wall with windows, doors, wiring and outside siding - are transported to
the site and assembled. The homes must meet State or local building codes where
they are sited.
Pre-Cut Homes: This is the name for factory-built housing in which
building materials are factory-cut to design specifications, transported to the
site and assembled. Pre-cut homes include kit, log, and dome homes. These homes
must meet local, State, or regional building codes.
Mobile Homes: This is the term used for factory-built homes produced
prior to June 15, 1976, when the HUD Code went into effect. By 1970, these homes
were built to voluntary industry standards that were eventually enforced by 45
of the 48 contiguous States.
107. The Lewin Group analyses for the Seniors Commission
from the SIPP database.
108. NCSHA, conversation with Jim Thatcher.
According to a survey of the State housing agencies in 2000, 22 percent of the
total production level of 60,000 units was developed as “seniors only” housing.
109. Huemann, et al, “The 1999 National Survey of Section
202 Elderly Housing, Public Policy Institute of the American Association of
Retired Persons, Washington, DC, 2001.
110. HUD, “Evaluation of the Service Coordinator Program:
August 1966”; Report to Congress: “Evaluation of the Hope for Elderly Dependence
Demonstration Program and the New Congregate Services Program,” June 2000.
111. Jeffrey Sacks, Esq., Brown, Rudnick, Freed &
Gesner, Boston, Massachusetts.
112. Rene Rodriquez, Executive Director, Miami Dade
Housing Agency, Miami Hearings, January 14, 2002.
113. Recommendations to the Seniors Commission, National
Rural Housing Coalition, October 2001.
114. Sue Harris-Green, Deputy Administrator for
Multifamily Housing, Direct Loans, Rural Housing Services, Washington, DC,
Baltimore Field Hearing, March 11, 2002. .
115. Subordination is a loan in a lower priority, for
example a second mortgage is subordinate to a first mortgage.
116. HUD, “Housing Our Elders: A Report Card on the
Housing Conditions and Needs of Older Americans,” November 1999.
117. Federally subsidized housing includes the following
housing programs: Sections 202, 236, 221(d)(3) Below-Market Interest
Rate, Section 8 New Construction and Moderate/Substantial Rehabilitation, and
515; conventional public housing, housing choice vouchers, and Low-Income
Housing Tax Credits.
118. Some housing projects have the financial capability
to use their operating budgets to pay for service coordinator positions.
The Commission believes that service coordinators should be included in the
operating budgets of all assisted elderly housing developments.
119. Janice C. Monks, Executive Director, American
Association of Service Coordinators, Columbus, Ohio Field Hearing, September 24,
2001.
120. Elderly Housing Coalition comments to the Commission,
March 15, 2002.
121. Jane Johnson, Director of Housing, Florida
Association of Homes for the Aging, Miami, Florida, Field Hearing, January 14,
2002.
122. Edward Salsberg, Director, Center for Workforce
Studies-SUNY Albany, Miami, Florida, Field Hearing, January 14, 2002.
123. Robyn I. Stone and Joshua M. Wiener, “Who Will
Care for Us? Addressing the Long-Term Care Workforce Crisis,” October 26,
2001.
124. Lynne M. Casper and Kenneth R. Bryson, “Co-resident
Grandparents and Their Grandchildren: Grandparent Maintained Families,” March
1998.
125. 1997 American Housing Survey cited in HAC’s 2000
Report on the State of the Nation’s Rural Housing. Washington, DC:
Housing Assistance Council, p. 7.
126. The Coordinating Council on Access and Mobility was
established in 1986 by the U.S. Department of Health and Human Services and the
U.S. Department of Transportation. The Council promotes quality
transportation services by encouraging the coordination of the program efforts
of government and nonprofit human service agencies with public transit and
paratransit providers. The Council brings together Federal agencies that
fund or purchase transportation services to improve the availability and quality
of community transportation services.
127. See: Jon Burkhardt, “Coordinated Transportation
Systems,” AARP Public Policy Institute, (2000).
http://research.aarp.org/consume/2000_16_transport_1.html.
128. Golant, Table 1.
129. A forward commitment is a financing tool for multi-unit, service-enriched
housing that can make the difference in whether a project is built.
Generally, a forward commitment provides the borrower with a locked-in
rate for the permanent loan in advance of the property being made available
to tenants, and allows developers to know what their debt service will be
in advance of construction. Fannie Mae's forward commitment has
financed market rate as well as affordable multifamily projects.
Freddie Mac has started a forward commitment program on a pilot basis.
Freddie Mac's program offers financing to build or substantially
rehabilitate garden or mid-rise apartments with either tax-exempt bond
financing or low-income housing tax credits.
130. Golant.
131. This refers to the Home Owners Equity Protection Act
(HOEPA), and it is one title under the Truth-in-Lending Act. The purpose
of HOEPA is to trigger specific discloses by the lender to the borrower on a
home equity loan when the interest rate and other closing costs cross a
threshold where the ACT deems the loan to be of “high costs”. It also
prohibits or limits certain types of equity lending practices typically used by
predatory lenders to drive up the cost of the loan to a borrower.
132. HUD Notice PIH 2000-41, Use of Housing Choice Vouchers in Assisted Living
Facilities, defines assisted living facilities as those that are designed for
residents who have the physical ability to live independently, but need
assistance with some activities of daily living. These can include
residential care facilities, adult care facilities, congregate care facilities,
or group homes.
133. L. Earl Armiger, for the National Association of Home Builders, President,
Orchard Development Corporation and Elderly Housing Coalition Recommendations to
the Commission, Baltimore Field Hearing, March 15, 2002.
134. Brian Burwell, “Medicaid Long-term Care Expenditures
in FY 2000,” March 7, 2001.
135. Enid Kassner and Lee Shirey, “Medicaid Financial
Eligibility for Older People: State Variations in Access to Home- and
Community-Based Waiver and Nursing Home Services,” AARP Publication No. 2000-06,
April 2000.
136. The AARP report that provides this information does
not list all nine States that allow a shelter deduction. It does, however,
mention the use of this deduction in Idaho, Nebraska, Tennessee, and Utah.
137. Mollica and Jenkins, 2001.
138. Keith Campbell, President and Board Chair, AARP,
Miami, Florida, Field Hearing, January 14, 2002.
139. D.U. Himmelstein, J.P. Lewontin, and S. Woolhandler,
“Medical Care Employment in the United States, 1968 to 1993: The Importance of
Health Sector Jobs for African Americans and Women.” American Journal
of Public Health, Vol. 86, No. 4, April 1996.
140. Richard J. Bringwatt, “Modernizing Medicare for
People with Chronic Conditions.” National Chronic Care Consortium,
August 2001.
141. Sharon Bloom, Executive Director, National PACE
Association, Miami, Florida, Field Hearing, January 14, 2002.
142. 1994 NLTCS, cited in Robyn I. Stone, “Long-Term Care
for the Elderly with Disabilities: Current Policy, Emerging Trends, and
Implications for the Twenty-First Century,” Milbank Memorial Fund,
2000.
143. National Academy on Aging 1997, cited in Stone
2000.
144. A Profile of Older Americans 2001. AOA
http://www.aoa.gov/aoa/STATS/profile/2001/1.html.
[ Index |
Summary of Commission Recommendations |
Previous ]
|
