OPENING KEYNOTE -- COMMISSION ON AFFORDABLE HOUSING AND HEALTH
FACILITY NEEDS FOR SENIORS IN THE 21ST CENTURY -- November 7, 2001, San Diego
Rev. Laverne R. Joseph, DD President & CEO, Retirement Housing Foundation, Long Beach, Ca.
Chair, California Association of Homes and Services for the Aging, Sacramento, Ca.

Good morning! Welcome to California and thank you for the opportunity to address the Seniors Commission today. I'm here in several capacities.

First, I welcome you on behalf of the California Association of Homes and Services for the Aging. CAHSA is headquartered in our State Capitol, Sacramento, and consists of almost 400 nonprofit providers of shelter and services in the whole continuum of care including home and community based services, affordable and market rate housing, continuing care retirement communities, assisted living and skilled nursing communities. I'm serving in my second year as Chair of the Board.

I also welcome you as President and CEO of Retirement Housing Foundation, a 40 year old nonprofit organization based in Long Beach, Ca. RHF has 132 communities in 24 states as well as Puerto Rico and the Virgin Islands. In our housing and health care facilities, we care for 14,000 persons every day, the majority of whom are low income seniors and persons with special needs.

Then, too, I welcome you as a former Board member of AAHSA, just completing my 6-year term of service on Sunday. During my life with AAHSA I chaired the Housing Committee 7 times and testified before Congressional Committees on Affordable Housing and Health Care issues 10 times including promoting the establishment of this Seniors Commission. It's wonderful to see your work moving forward with the capable leadership of many of my colleagues.

I had the opportunity to give the opening reflection for the AAHSA Conference on Sunday, and among other things I said that since the terrible events of September 11, there has been a call for life to return to normal, but it never will return to the old normal. There will be a new normal with higher security and many other changes to the way we live. As advocates and nonprofit providers of shelter and services, we also are looking for a new normal:

We are looking for a normal in which persons do not need to make desperate choices of whether to pay the rent or purchase medications or eat.

We are looking for a normal in which there is an affordable, accessible, understandable, ethical and sensible delivery system of shelter and services for older adults.

We are looking for a normal in which caregivers are respected, valued, and properly compensated through a reasonable reimbursement system by both federal and state agencies and where regulators seek to reward best practices.

September 11 has been called a wake up call for America's security. I am hopeful that this Commission proves to be a wake up call for addressing in new, creative ways the needs of our nations seniors. There is an age wave sweeping through our nation and we simply are not prepared for it. Even now in some of RHF's affordable housing facilities we have waiting lists as long as 8 years. And that's before the baby boomers double the number of our nation's seniors. Furthermore, 70 % of seniors in these communities do not leave voluntarily - they either die or they age in place with ever increasing needs due to frailty. We have addressed that aging in place by competing for social service coordinator grants from HUD, and just last week received grants totaling $1.6 million to add service coordinators to 16 more communities. That program needs to continue and be expanded because it saves valuable dollars in that unless services are brought to a senior's place of residence, the typical resident in affordable housing - a single female on social security - will have no alternative except a nursing home which costs the government considerably more to support.

Another valuable option for low income frail seniors is to provide section 8 subsidies for the shelter and Medicaid waivers for the services to make assisted living truly affordable. Assisted living, while it costs less than skilled nursing, is not affordable to someone getting by on social security without some such creative solution. With the support of the Seattle Housing Authority, the state of Washington and HUD, RHF will open such a facility next month in Seattle.

One of the great ironies is that while there is this aging explosion, we are producing annually only 6,000 new units of 202 affordable housing compared to 20,000 annually 20 years ago. The 202 program is the best affordable senior housing program available with the highest accolades from residents as well as government, and it needs to be expanded.

Ironically, at the same time, we are losing affordable housing units at an alarming rate. It's estimated that between 1997 and 1999, 300,000 units were lost as for profit providers opted out, sold or converted to market rate housing. In addition to developing new housing stock, RHF is also attempting to preserve existing inventory. With the assistance of the Massachusetts Housing Finance Agency, HUD, and the Low Income Tax Credit program, RHF recently purchased two buildings containing over 400 units in Boston from a for-profit provider who is planning his own retirement. We have a verbal agreement to purchase and preserve his entire inventory. Transitioning the existing for profit inventory to nonprofits should be promoted and enabled by government in order to preserve the affordability of these valuable social assets.

Housing is critical to health care. Fortunately, more and more government leaders are becoming aware that we simply cannot have good health care in our country unless persons have safe, secure, affordable shelter.

Another part of the demographic shift is that there simply will not be enough younger care givers to provide services to those who need them. There are not enough now, partially because reimbursement will not allow providers to pay a reasonable wage. Higher reimbursement will help, but there needs to be creative programs to get persons into the profession much like when we faced a teacher shortage.

Two additional issues face skilled nursing long-term care providers. One is litigation and the other is the high cost of insurance which is mainly driven by the litigation. Nonprofit providers have never been in it for the money, but we also cannot let our entire mission be collapsed by the cost of litigation and insurance. RHF is currently in the process of selling our only free standing nursing home because we cannot afford to subsidize the million and a half dollar annual loss. Had insurance premiums remained where they were 3 years ago or increased with the cost of living, it would have been a break even operation. I know of numerous nonprofits who are either closing or leaving this part of the continuum. We do believe that bad providers should be punished, but part of the problem is that our youth oriented culture fails to distinguish between what is poor care and what is, unfortunately, part of the normal aging process. Enterprising attorneys capitalize on the guilt and greed of family members, and juries fail to recognize poor care from normal aging, partially because the media reports on horror stories and not the reports of hundreds of thousands of satisfied customers.

Speaking of satisfied customers, I have packets of information for you on RHF's mission and, in that packet, is a book we produced for our 40th Anniversary. We invited staff, volunteers, and, most importantly, residents to write about the difference our mission has made in their lives. It makes good airplane reading, and if anyone ever wants to know why faith based mission driven organizations are in this ministry, these stories will tell you why.

I will close with a personal story that happened to me when we were dedicating an affordable senior community in Anaheim, California 11 years ago. After the ceremony, a lady came up to me and said, "I want to tell you my story. Before I came here, I was living on social security of $690 a month. My rent was $550 a month and going up every 6 months. You have made it possible for me to live and to enjoy life again, and I thank you." That is why we do what we do, and that is why we are counting on this Commission to wake up our government at every level and our society to address creatively the needs of seniors in this 21st Century. The nonprofit providers are anxious to partner with you in addressing the needs.

In our closing general session this morning, our featured speaker concluded by stating, "When all is said and done, more is said than done." We are all counting on this Commission to assist Congress and our nation in doing all the good words that are said in these hearings. Again, thanks for the opportunity and the privilege!