Testimony to
The Commission on Affordable Housing and Health Facility
Needs for Seniors in the 21st Century
November 7, 2001
by
Sally Little, Vice President Affordable Housing
Southern California Presbyterian Homes

In offering testimony to the Commission I bring twenty years of "hands on" experience with facility residents as a Resident Service Coordinator and for the past 10 years in the management of 14 Affordable Communities for Seniors. Some of the issues and concerns remain the same and some new problems have been uncovered. My focus is primarily on low income seniors.

• TRANSPORTATION - In a recent survey conducted in a Southern California city it was found that transportation continues to be one of the most frequent problems for seniors. This has been an issue for many years. Although there are ride programs in most communities they are often not adequate for the demand. Often transportation is late, doesn't appear or may not be accessible. This can lead to isolation and foster the loneliness that can impair a person's life. It may mean missed appointments, inability to shop for food and a feeling of loss of control.
• HOUSING - Along with transportation, housing needs are at the top of the list. Affordable Housing is non-existent in some cities and other cities have waiting lists for housing that are 3 - 7 years long or longer. These lists continue to grow and each new facility that is constructed opens with a waiting list. In Glendale, California a new facility was opened two years ago for low income seniors. Fifteen hundred applications were submitted for 40 apartments.
• ACCESSING SERVICES - Seniors and families are often unaware of the services that are available and less familiar with the implementation process. HUD funded senior housing is now providing access to services through the Service Coordinator program. For seniors who may not be part of a program or for those living alone in the larger community there is a lack of this kind of assistance. These seniors are more at risk for possible premature institutionalization.
• HEALTH CARE - Two risk factors for the older adult are impaired emotional status and mobility issues. The same study as mentioned above found that loneliness and depression, often due to isolation, are major problems. Health Care professionals may misdiagnose or blame it on "getting older". Therefore the emotional issues are neglected. The second most frequent impairment was mobility which put the senior more at risk for falls and also inhibited the ability to be as independent as in the past. Again, lack of transportation for mobility impaired is a problem.
• IN-HOME HELP - There are currently agencies, i.e., In-Home Supportive Services that provide assistance with cleaning, shopping and cooking. However, it is up to the senior to find someone that can do these chores. The senior may not have had the experience in the past of interviewing for this kind of assistance or may not even be sure what they could expect of the worker. There are many documented horror stories of workers who have taken financial advantage of the senior employer and in some cases, have also been abusive. At this time we are working with a senior in one of our communities whose in-home worker changed checks to read $800 instead of $8.00. The police are currently looking for that worker who has so far embezzled $9,000 from this senior.
• EDUCATION - Seniors are more interested in learning, especially with computers. Due to monetary constraints in Affordable Housing it is often difficult to access equipment needed to assist with learning.
• FINANCIAL CONCERNS - This rarely comes as an admitted concern from seniors. As part of a grant that included a research component done by the University of Southern California, we have found that many residents in affordable housing have difficulty with budgeting and with many aspects of handling finances. A major issue has been the inability to pay rent due to poor management of resources and easy buying through catalogs and TV programs. This can lead to eviction. Another area of concern has been the lack of knowledge of this country's financial system due to migration from other country's and possible language barriers. Even check writing and banking business has been an unknown for those particular seniors.
• CULTURAL DIFFERENCES - The senior population in Southern California is made up of many nationalities, languages and income levels as well as a myriad of other factors. It is often a challenge for those company's operating senior communities to understand cultural differences and to be able to provide for needs of each group. Education of those serving seniors continues to be a priority.

LISTED BELOW IS THE SUMMARY OF NEEDS FROM A RECENT SENIOR SURVEY IN ORDER OF PRIORITY:

• Transportation
• Housing
• In Home Help
• Legal
• Health Information
• Employment
• Support Groups
• HICAP
• SS/SSI Information
• Meals on Wheels

RECOMMENDATIONS:

• TRANSPORTATION - Promote an incentive for cities that provide additional transportation to seniors, fund vans for senior facilities, provide additional taxi vouchers, provide buses dedicated to accessible senior transportation. Possible use of unused school buses, i.e., during school hours when buses are not being used or on weekends. Encourage senior centers to become transportation hubs.
• HOUSING - Continue and add to the funds from U.S. Department of Housing and Urban Development (HUD) to provide additional senior housing. Incentives from the State Governments to cities who do thorough investigations and assessments of senior housing and service needs. Federal Government encouragement of States to develop consolidated plans that address the housing and service needs of seniors with some consideration of funds that could be used to add to the current supply.
• HEALTH CARE - Encouragement of physicians and other health care providers to treat seniors as vital members of society and to be proactive instead of reactive. Incentives for young professionals to enter the field of gerontology. Development of seniors as teachers and mentors for those who are serious about becoming gerontologists or service providers so they can learn first hand of the needs. Continue to examine medicare and medi- cal and the reimbursement rates, in particular the pharmaceutical package. Incentives to drug companies for lowering cost of drugs so that use is not discontinued due to cost.
• IN-HOME HELP - Provision of training seminars for seniors at community centers to learn how to interview and ask for references and how to safeguard themselves against fraud or abuse. Develop a system that allows the In-Home Supportive Services program to finger print and train and supply a list of workers who do not have criminal backgrounds. Increase government funding in order to pay workers and adequate wage.
• EDUCATION - Develop grants that provide computers and computer training for seniors. Intergenerational programs that give students credit for teaching seniors to use computers.
• CULTURAL DIFFERENCES - Required education for students in all fields regarding differences and similarities of all cultures.
• FINANCIAL CONCERNS - Implement a program that provides training for social workers who could be bonded to assist seniors with understanding budgets, banking systems, safety deposit boxes, etc. Provide space at senior centers for the "Financial Assistant" to meet with those requiring assistance.

LEGISLATION:

Those of us who are strong Senior Advocates, even with the impact of the current world developments, continue to dream of what is needed to fill the void that is often felt by seniors.

• Federal or State legislation to provide funds for Senior Buses and Vans just as School Buses are provided. This, in the long run, might save money as well as lives and would certainly improve quality of life.
• Adequate funding for the U.S. Department of Housing and Urban Development to continue and expand the Affordable Housing Senior 202 program. This program has proved to be an excellent example of housing and services that assists seniors in remaining independent while providing a service coordinator program to assist with accessing of services. This program has proactively worked towards allowing seniors to have quality of life in their own apartments instead of an institutional setting. It is also cost effective.
• State funding to provide a state wide listing of housing and services available to seniors throughout each state. Funding would be very little if the assistance of gerontology programs at universities were accessed.
• Health Care will continue to be a concern as the issue of HMO's versus private medical practices is sorted out. Coverage is inadequate and often diagnosis and treatment is so time limited that seniors are returning from surgery and other illnesses without adequate care.
• In-Home Help Legislation is needed to provide funding to pay in-home workers adequately. Again, this is a cost effective way to avoid premature institutionalization in a higher level of care. Legislation also is needed to give the Department of Social Services or a like agency the authority to train and fingerprint in-home workers. Adequate funding for this providsion would also be needed.
• Financial Assistant Program might require legislation to assist senior centers in setting up a pilot program with some funding for training. A possible solution could be to train an employee at a senior center who is already familiar with seniors and their issues. This could prevent loss of funds through fraud, abuse, misuse of income and could even prevent eviction.
• An effective way to link seniors with services, especially in affordable housing, has been through the Resident Service Coordinator Program. Legislation that provides for the continuation of that program through the facility budgets is important. This program has given many seniors the ability to remain in their own homes for an indefinite period of time, as long as they are mentally competent to make decisions.

Those of us who continue to work with seniors are finding a bold and knowledgeable group who are ready to advocate for themselves. As this group continues to grow in size they will play an ever stronger role in requesting that their needs be met. It is imperative that we begin to realize this and to fill the gaps that now exist.