Testimony to
The Commission on Affordable Housing and Health Facility
Needs for Seniors in the 21st Century
November 7, 2001
by
Statement of James J. Brigl, Executive Director
Housing Research Foundation

Good morning. My name is Jim Brigl and I am the Executive Director of the Housing Research Foundation located in Washington, DC. HRF is the only nonprofit research organization dedicated exclusively to studying issues affecting America's public housing and the families which it serves. I would like to thank the Commission for inviting me to testify today about the characteristics and needs of the nation's public housing and its older residents.

The first time our country truly confronted the housing conditions of the elderly was at the end of the 1950s. Then, in an era of comparable prosperity, when one in three elderly households lived in poverty and almost one in four lived in substandard housing, the nation turned to its public housing system. Local public housing authorities, building on their experience in developing affordable rental housing and their public mission to serve our most vulnerable citizens, responded immediately.

Public housing became the vanguard of the nation's commitment to housing seniors. In the 1960s and 1970s, local public housing authorities built an estimated 250,000 units of rental housing specifically for seniors and welcomed many thousands more into existing family developments. By 1977, 540,000 older Americans headed 45 percent of all public housing households, compared to only 11 percent twenty years earlier. Public housing was home to 10 percent of all elderly renters in the United States.

In the years since, public housing has succeeded on its own terms: quietly, and in spite of many obstacles, it has provided decent, affordable independent living for our nation's poorest elders. Though often overlooked by policymakers, it remains the largest single source of housing assistance for low-income seniors, and thus an indispensable part of any strategy for responding to the coming senior tsunami of retiring baby boomers.

Few would dispute that public housing residents are among our nation's poorest and most vulnerable elders, but data on this population is scarce indeed. HUD has never fully analyzed its significant data on elderly resident characteristics and property conditions. At the same time, it either does not provide access to independent researchers or releases it only in summary formats that are of limited utility and plagued by missing data. The Housing Research Foundation has used the two primary public use files-a 1997 public use microdata file from HUD's Multifamily Tenant Characteristics System and property-level summary data from the 1998 "Picture of Subsidized Households," and supplemented this limited information with other data sources -to piece together a general snapshot of the senior-occupied public housing stock and its residents.

While estimates vary, sometime widely, approximately 700,000 persons age 62 years and older live in public housing today. The exact number is up for debate. This fact speaks volumes for the need for solid, accessible and credible information.

Public housing's seniors are older than the general U.S. elderly population. Almost one in five elderly public housing households is headed by someone age 85 or older, compared to about one in nine nationwide.

…and many have grown old in their public housing communities. Almost one-fourth of elderly public housing households have put down roots in their public housing communities, living in their units for a decade or more.

Almost half of all elderly public housing residents are minorities. The face of the elderly in public housing is quite different from that of other U.S. seniors-as well as from public housing's family population. In public housing, 25% of the elderly are African American and 13% are Hispanic, whereas, in the general population the numbers are 9% and 4% respectively.

Most elders in public housing live alone, and almost three-fourths of these solitary seniors are women. Many older Americans come to live in public housing precisely because they lack the familial and social supports that can help them remain in their own homes: only 6 percent of older public housing households is made up of a married couple, while 83 percent are single persons living alone. This has significant implications for the industry as elders become more frail and in need of support.

Public housing serves more lower income elderly households than most other federal housing assistance programs. The median annual income for seniors in public housing was $7,855 in 1999-barely a third of the median income of other elderly households. More than half of all seniors in public housing live below the poverty line. Almost 2 million U.S. senior households still lack the basic economic resources needed for daily life. Public housing houses about 10 percent of these households nationally.

Seniors in public housing are more likely to experience levels of disability or frailty. This is hardly surprising: the most conspicuous demographic characteristics of public housing seniors are precisely those most strongly associated with poor health: advanced age, extremely low income, minority status, living alone. Data drawn from a special supplement to the 1995 American Housing Survey found that an estimated 20 percent experience difficulty with at least one Activity of Daily Living (ADL), compared to about 12 percent of the general population.

In Florida, where the demographic bulge of seniors already resembles what other regions will see in the coming decades, almost one-third of elderly public and assisted housing residents surveyed in 1997 needed at least some help with ADLs. And in Baltimore, a study of six public housing highrises for seniors found that 27 percent of elderly residents had a current psychiatric disorder (most commonly a cognitive disorder); 37 percent needed mental health services but fewer than half of those were receiving them.

Elderly public housing residents, economically disadvantaged, physically frail, and often at serious risk of institutionalization, represent a tremendous challenge for the public housing authorities to whom they must look for affordable, flexible community-based housing and service options that can continue to accommodate their frailties and respect their autonomy as they age.

Elderly in public housing need a more effective lobby. Seniors living in public housing, while a large group, are often a group with a quiet voice. Resident groups are more often comprised of families with children than of older single residents. The major industry groups in the country have concentrated on addressing the issue of younger disabled living with the elderly but largely have not jointly addressed the more comprehensive current and future needs of the elderly in public housing. Public housing has fallen behind in its ability to serve the elderly, often, by simply standing still. With few exceptions, the nation's stock of public housing for the elderly has not been able to respond to the growing frailty of its residents, the influx of younger disabled persons, the increasing demands on its management, the mounting competition from other types of assisted housing, or the recent innovations in supportive living. Seniors living in public housing need a voice.

Physical deterioration. Much of the senior-occupied public housing stock is over 30 years old and, without major repair and modernization, is nearing the end of its useful life. HUD-estimates of the cost of modernization needs are notoriously low and flawed but even by these estimates, the bill for simply returning developments for the elderly to standard condition would be well over $4 billion and rising at a huge rate.

This does not take into consideration the functional obsolescence of much of public housing for the elderly. It was built without basic unit safety and accessibility features, and also lacks basic amenities, including community or dining rooms and program space for delivering supportive services. Slightly over half of elderly public housing residents are living in buildings designed (and currently operated) as family developments. Accessibility features and appropriate supportive services are often less available to seniors in larger develops in which the population includes younger residents.

Competitive disadvantages. Despite the persistent need for affordable housing among older Americans, waiting lists for public housing for the elderly are generally short. The reasons for this phenomenon are complex, but housing authorities, particularly in large- and medium-sized cities, note that many seniors shun their many high-rise developments with their large stock of efficiency units. There is also concern that there is simply too much rent-subsidized independent living for seniors in some markets where housing authorities and, notably, Section 202 sponsors both turned aggressively to housing the elderly.

Younger and Older Together. One of the greatest challenges facing public housing for the elderly today is the influx of younger disabled households, who receive the same priority for admission to public housing as elderly households. Younger households with chronic physical and mental disabilities, often lacking other housing options in their communities and needed support services, represent 20% of all households in senior developments. The lifestyle differences with existing older tenants, as well as the management challenges for housing authorities ill-equipped to respond to the special needs of the mentally disabled, have led to renewed talk of "tipping points" at which the presence of younger disabled households make it impossible for PHAs to attract or retain seniors to particular developments. This has been an enduring issue. In 1992 Congress authorized housing authorities to "designate" part of their stock for elderly occupancy only, but this remains a fairly limited phenomenon-by the end of 1997, only 73 PHAs had submitted allocation plans that designated approximately 25,000 units as elderly-only.

Meager supportive services. In the absence of objective information, it is widely accepted that the overwhelming majority of public housing does not provide many of the services-personal care, transportation, case management, social outreach, and most crucially, onsite health services-that frail and at-risk seniors may need to maintain their independence and a high quality of life. There are fewer than 5,000 units of HUD-funded congregate housing in the national public housing inventory. Service coordination has been a very successful strategy where it has been implemented, but the extremely limited HUD funding available under the this program reaches fewer than a hundred PHAs annually. Only a handful of PHAs have been able to gain access to Medicaid waiver funds for assisted living or other needed supportive services.

Most PHAs, largely bereft of funding, facilities, and expertise, have had to rely on local nonprofit eldercare networks or on the tireless and creative ad hoc efforts of individual public housing property managers and staff to create supportive living environments and connect their poor and often isolated tenants with needed sources of assistance. And in a growing number of communities there are emerging stories of housing authorities forming partnerships with both nonprofit and for-profit organizations to assemble enriched housing opportunities for seniors under the broad rubric of "assisted living." In addition, a few public housing authorities are starting to use the resources and flexibility provided by the HOPE VI program and other emerging mixed-finance tools to undertake comprehensive revitalization and development efforts to provide competitive residential assisted living for older public housing residents, sometimes in a mixed-income setting.

Currently, researchers and policymakers have no way of gauging the extent of these experiments or the diverse needs of the hundreds of thousands of older Americans living in public housing. So this winter, the Housing Research Foundation will conduct the first nationwide survey since 1987 intended to examine the public housing system's stock, elderly resident characteristics, service needs and strategies.

As the national population of seniors continues to grow, the number of seniors in need of affordable housing and care is rising dramatically. In the next ten years, the baby boomers will begin to turn 65. The size of the elderly population is expected to double by 2030. The number of seniors who are 85 and older - whose wealth and health are often the most precarious - will also more than double. Given these statistics, it is imperative that those involved in the delivery of public housing prepare NOW to meet the needs of an increasingly old and frail population.

Recommendations

We make the following recommendations:

• HUD should release additional detailed and specific demographic information regarding those who populate public housing for the elderly and the conditions of the buildings in which they live. The Department should join with the industry in developing a credible and comprehensive description of the elderly, their needs, the true condition of the housing stock and the cost of bringing it up to standards that promote healthy and independent living.
• The Housing Research Foundation should convene the major industry groups, i.e., NAHRO, CLPHA and PHADA, advocates for seniors, and other key players to form a "Seniors in Public Housing Task Force." The purpose of the task force would be develop and examine the data, promote and foster an advocacy role for public housing seniors, discover alternative models for providing housing and services to seniors in public housing, and develop policy recommendations for HUD and the Congress that address both present and future needs.
• Congress should fund, and HUD should implement, demonstration projects for congregate housing programs that provide the necessary physical and support services by which seniors will be able to continue to live independently. Funds should be used to renovate existing living facilities to make them accessible, provide facilities for support services - including health facilities - appoint service coordinators to oversee the provision of services and to fund assisted living and health services.

Public housing today provides decent affordable housing to an increasingly frail, often quiet, population. To help maintain the independence of the seniors it serves, it must be given the resources to provide various types of housing and service configurations for a growing population. It can succeed in this endeavor if it is fully integrated into the larger seniors housing debate, gives seniors in public housing a voice, has a credible and accurate information base from which to make policy recommendations, and is adequately funded to provide cost effective answers to a growing challenge. Thank you for hearing my testimony today.