SUMMARY OF COMMISSION RECOMMENDATIONS

RECOMMENDATION NO. 1
PRESERVE THE EXISTING HOUSING STOCK

1. Encourage the preservation, renovation, and refinancing of affordable housing projects.



2. Preserve the existing stock of Section 202 units as affordable service-enriched housing and encourage the renovation and refinancing of Section 202 projects.



3. Continue to encourage the renovation of our aging public housing stock and allocate resources to housing authorities to provide service-enriched housing.



4. Encourage utilization of HOPE VI modernization funds to build new independent and assisted living facilities for seniors and to retrofit housing stock to make the necessary unit and physical plant improvements to better serve senior Americans. Require the development of a relocation plan for seniors that assures each displaced senior an affordable, accessible living unit with appropriate services.



5. Congress should fund the modernization and replacement of out-of-date capital items as well as additional space for supportive services and programming.



6. Congress should continue to support programs for senior homeowners to maintain their homes and maximize their ability to live there as long as possible.



7. Recognize manufactured housing as an affordable housing option and encourage reasonable financing products.

RECOMMENDATION NO. 2
EXPAND SUCCESSFUL HOUSING PRODUCTION AND SERVICES

1. The Commission recommends an increase in the annual production of all types of assisted housing in order to meet the needs of future generations of seniors.



2. The Section 202 program is the primary production program serving extremely low- income seniors, and funding for this program should be increased to keep pace with the demand.



3. HUD should increase the Section 202 per unit funding allocation to cover the realistic cost of development, including the cost of public and administrative spaces. HUD should establish reasonable operating cost standards to cover service coordination and other related expenses.



4. Congress should provide greater clarification on the recent changes that permit combining Section 202 and the low-income housing tax credit.



5. Amend the low-income housing tax credit program to provide a credit boost of 15 percent for service-enriched senior housing.



6. HUD should revise its Section 202 allocation system to more appropriately target geographic areas of greatest need.



7. Medicaid funding should be adequate to support quality care. Payments should be consistent with Federal quality standards and should be adequate across all settings.



8. Congress should modify rural housing programs to more appropriately serve seniors and fund them realistically.



9. increase the availability of appropriate home- and community-based services in rural areas. Congress should enact a new flexible rural waiver demonstration program that authorizes targeted funds to States and their rural communities.



10. The Commission strongly supports existing efforts by Fannie Mae and Freddie Mac to develop single-family programs that meet the needs of elderly who desire to age in their own homes.

RECOMMENDATION NO. 3
LINK SHELTER AND SERVICES

1. Congress should take all necessary steps to improve and fund service coordination in federally assisted senior housing.



2. Revise the Assisted Living Conversion Program (ALCP) to facilitate its use by housing sponsors.



3. The Department of Health and Human Services and the Department of Labor should develop collaborative initiatives to target Work Investment Act and other Federal dollars to the long-term care field.



4. Congress should direct the General Accounting Office (GAO) to conduct a comprehensive evaluation of interdepartmental operations between HUD and HHS and give recommendations on how to more effectively coordinate the provision of housing and services to seniors.



5. Congress should recognize and facilitate intergenerational living environments.



6. Congress should continue to support State and local transportation programs enabling communities and other sponsors to offer private taxis, handicapped accessible vans, ridesharing, and other creative transportation assistance especially in rural areas.



7. Congress should expand the Department of Transportation/DHHS Coordinating Council on Access and Mobility to include all appropriate Federal agencies that can facilitate the removal of barriers to a coordinated, accessible transportation network for seniors.

RECOMMENDATION NO. 4
REFORM THE FINANCIAL DELIVERY SYSTEM FOR HOUSING AND SERVICES FOR SENIORS

1. The government sponsored enterprises (GSEs) need to increase their involvement and become major players in financing housing for the growing number of seniors.



2. The Federal Housing Administration (FHA) should meet the challenges of the 21st century by re-aligning existing mortgage insurance programs in order to play a significant role in senior housing and health facility lending.



3. Congress and HUD should continue to support and improve the reverse mortgage program and home equity programs.



4. The FHA and the GSEs should strengthen efforts to protect seniors from abusive lending practices. Policies to assure security of senior homeowner mortgages should be vigorously enforced.



5. HUD should establish higher fair market rent (FMR) standards for units in assisted living facilities and other service-enriched housing than the FMR currently established for comparable independent apartments.



6. Congress should increase the Medicaid matching rate for HCBS waiver services, so that States have an incentive to expand services to individuals who live in their own homes or in alternative residential settings, such as congregate housing or assisted living.



7. All seniors who receive home- and community-based services (HCBS) under Medicaid should be offered the option of arranging their own services and choosing their own providers, where appropriate.



8. Congress should require the States to authorize a Medicaid shelter or housing expense allowance in determining Medicaid eligibility for all HCBS waiver programs, providing necessary Federal financial assistance to states through enhancement in the Medicaid matching formula.



9. Congress should modernize Medicare to address the growing needs of seniors with chronic conditions.



10. The Department of Health and Human Services (HHS) should explore ways in which State Medicaid programs can increase reimbursement rates paid to providers and ensure that these increases are reflected in the wages of long-term care workers.

RECOMMENDATION NO. 5
CREATE AND EXPLORE NEW HOUSING AND SERVICE PROGRAMS, MODELS, AND DEMONSTRATIONS

1. Create a clearinghouse of information to gather and disseminate information about State Medicaid programs that deliver HCBS.



2. Require HUD to develop and maintain a national database of senior housing.



3. Congress should encourage and, as needed, authorize the secondary market GSEs to develop model senior housing demonstration programs that lead to permanent and meaningful change in the delivery of service-enriched housing.



4. Fannie Mae and Freddie Mac should develop effective rural programs. Further, HUD's enforcement of the GSEs' rural lending goals should take into consideration their effectiveness in providing financing to small, difficult-to-serve rural communities.



5. The Federal home loan banks and the Federal housing finance board should identify, and the bank system should promote, ways in which Federal home loan bank system products and authorities can be used to serve the housing and health facility needs of seniors.



6. The Federal home loan bank system's programs should be fully utilized in rural areas.



7. Congress should address the need for a prescription drug benefit for seniors.



8. HHS should accelerate the transition to permanent programs of those HCBS demonstrations that have been shown to be effective, and encourage the broader implementation of the Programs of All-inclusive Care for the Elderly (PACE) model by identifying and eliminating barriers to its expansion.



9. Congress should consider enacting a refundable tax credit available to individuals with disabilities or by families that care for a senior with disabilities.



10. Support private sector development of housing with services.



11. Congress should consider the creation of a tax incentive for individuals purchasing long-term care insurance.

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