1

Senior Living Now

LeadingAge Minnesota – July 21, 2016

Colleen Bloom, Director for Housing Operations

LeadingAge, Washington D.C.

cbloom@leadingage.org

National HUD Update

my.leadingage.org

Tailored subscriptions for

personalized areas of interest, critical

news and member-to-member

listservs

LeadingAge Housing Agenda

2

A Quick Federal Funding

and Legislative UpdateLeadingAge Affordable Senior Housing Policy Agenda:

• Hold the line on appropriations, especially Project-Based

Section 8, PRAC, SPRAC renewals

• Support the President’s budget request to expand RAD

program eligibility to include PRACs

• Advocate for continued growth of Service Coordination

• Promote full preservation strategy for the Section 202 PRACs

• Protect the 4% Low Income Housing Tax Credit (LIHTC)

• Explore new financing alternatives for affordable housing

development

• Continue support for the National Housing Trust Fund

• Push for an alternative to sequestration

Housing as a Platform for Senior HealthBiPartisan Policy Center:

Healthy Aging Begins At Home

Priority recommendations include:

• Adequately fund Section 202 (subsidy/SC)

• Support aging-in-place/community retrofit

• CMS to coordinate health care /

LTSS for Medicare beneficiaries

living in publicly-assisted hsg

• Reimburse for more telehealth

3

LeadingAge Senior Housing Priorities

Affordable Housing Financing Cabinet

• New Flexible Capital Options

• New Platforms & Subsidies

• Wrapping Housing with Services

Public Policy Congress

• Finding Champions on Capitol Hill

PRAC Preservation Strategy

• RAD for PRAC

PRAC Preservation

• Workgroup formed - October 2014

• Survey conducted - Spring 2015

• LeadingAge discussed regulatory options with

HUD (Summer/Fall 2015)

• Task Force preliminary recommendations

drafted – October 2015

• Dialogue on asset management reforms

• Senate already supports RAD for PRAC

Recent Victories on the Hill !!

• RAD for PRAC clears Senate appropriations

• Older Americans Act

• Tax Credit – 9% made permanent

• National Housing Trust fund not repealed –

first funding due to go to states this summer

More Notable Developments

• HOME funding increased

• Rural Rental Assistance (RA) shortfalls restored

• Energy & water conservation demo

• 3-year certifications approved

4

Government Funding for Low-Income Rental

Assistance and Housing Development ProgramsAffordable Senior Housing Legislation

(FY17 and Beyond):

• HR 3700 – HOTMA (AHSSIA; SESA; SEVRA) –

continued efforts at Section 8 reforms

• Addressing PRAC Preservation

• Energy Efficiency

• Sequestration

• Congressional Strife

• Election Year

HR 3700/HOTMA

• Raises elderly/disabled standard deduction to $525 (from $400) and indexes it to inflation in future years**

• Allows/Raises deduction for medical and disability expenses above 10% of income (instead of 3%)

• Leaves dependent deduction unchanged, but indexes it to inflation in future years

• Includes hardship provision **

**HUD proposal does not include

More on HOTMA

• Eliminates temporary disregard of earnings increases

for voucher holders with disabilities and public

housing residents

• Only requires inclusion of imputed income from

assets above $50K (compared to $5K today)

• Excludes veterans’ aid and attendance expenses from

income

5

HOTMA – Rents Process Changes

Changes would reduce administrative burden for agencies and owners and encourage work

• Interim recertification only for income reductions and unearned income increase above 10%

• Prohibit interim reertification for earnings increases(unless the increase comes after a downward recertification for an earnings decrease)

• Requires use of prior-year income, except when a family first receives assistance and for interim recertifications

• Allows housing agencies to rely on income determinations from SNAP and other means-tested programs

Appropriations 2017

• Challenges:

– Time crunch, Zika fight, amendment

clampdown, left-over bills, defense disputes

If another omnibus/micro-bus, some

administrative (HOTMA) Section 8 reforms might

be included

What YOU Can Do

Tell your story; tell resident and client stories –

educate on “real” value of housing in community

• Get Lawmakers to Visit Residents/Sites

• Look to the tools on LeadingAge website

– Contact Congress; Congress to Home

– Sign-up for LeadingAge Housing Advocacy list

– Sign-up for Senior Action Network

• Communicate specific messages to key legislators(recommendations will be sent to your state staff!)

Seniors Action Network

6

Operations Update

• Transformation Enters Final Wave

• PBCA Rebid and MORs ssssssssssssssssssssss

• Service Coordinator Funding ……….……………...

• ………………….Latest Operational Directives

• ..

• REAC Inspections

• Smoke Free ……………………………

• Homeless Preference

• Energy Efficiency and Benchmarking

HUD Changes

Waves 4 and 5 in progress now

7

PBCA Rebid

• Current contracts in 42 states extended

through Dec 2017

• Procurement protocol and new attention to

“grants management” processes

• Risk-management implementation (3-2-1)

Criminal Screening

• NO blanket policies blocking applicants for

simply having arrest record or criminal history

• Must individualize for timing and severity

• FHEO largely focused on drug related crime

(possession, not distribution)

• Violent crimes NOT targeted, but….

• Still need to explore extenuating

circumstances

Rent Comparability Studies

Proposed Changes Comment submitted in April

• Increasing influence of RCS in rent setting

• Market is market, yet HUD proposed caps on

non-shelter service adjustments

• Proposed changes not yet in effect

• LeadingAge seeking broad-based stakeholder

discussion, including appraisers

Service Coordinators

• Payment moving to Calendar Year(get all renewals through Dec 31 to HUD ASAP!)

• Reporting in a timely manner will be tied to

timely payments

• HUD preparing for more consistent policies

(desk audits

8

REAC Inspections

• New “Industry Standard Repairs”

– for effect Aug 1

• Integrating use of photos into inspection

processes, and appeals

• No “currently licensed UPCS inspectors” as

site-based contractors

HUD Recommendations

• Offer a preference for homeless,

collaborate locally ssssssssssssss

• Go smoke free

• Explore Energy Efficiency upgrades,

and benchmarking tools

• Preserve your properties!

Homeless Preference Encouraged

• Distinct phenomena – expanding need; early aging

• Notice H 2013-21 – provided flexibility in owner

choice and definition

• Toolkit issued Nov. 2015 – guidance and tools for

coordinating access and resources

• Google: HUD, opening doors, homeless toolkit

9

Housing Plus Services:

Expanding the Future of Aging

Services

Engaging Health Partners to Serve

Low-Income Older Adults

Housing with Services

• Health and long-term care reform

efforts at national and state level

• Goal: Improve health care outcomes for all

Americans, particularly vulnerable populations

• Affordable senior housing residents represent

the vulnerable individuals population-based

health reform efforts are designed to target

Supportive Services Research Demo

Develop a housing-with-services demonstration program for low-income elderly to test models that demonstrate the potential to delay or avoid the need for nursing home care.

Produce evidence about the impact of housing w/ services on:

• housing stability

• wellbeing

• health outcomes of HUD-assisted elderly residents costs to the health care system

10

LeadingAge Housing Agenda MacArthur Study – Jan 2016

• Previous research: “A Picture of Housing and Health”

• Matched 2008 HUD tenant-level with Medicare and Medicaid

admin data for individuals receiving HUD assistance in 12

areas (HHS/HUD dataset)

– Almost 70% of HUD-assisted adults age 65+ identified as

Medicare beneficiaries were dual eligibles

– 55% of HUD-assisted, dual eligible older adults had 5+ chronic

conditions, compared to 43% of peers not receiving HUD

assistance

– HUD-assisted, dual eligible older adults had 16% higher FFS

Medicare costs and 32% higher FFS Medicaid costs than peers

not receiving HUD assistance

Available Services Staff, 2008

69%

26%

13%

25%

Service Coordinator Activity Coordinator Nurse No Staff

SC

44%

SC/AC

14%

SC/N

5%

SC/AC/N

5%

AC

5%

AC/N

1%

N

1%

No Staff

25%

Available Onsite Services, 2008

27%

3%

10%

10%

19%

24%

31%

64%

66%

49%

33%

44%

74%

Podiatry

Dental

Mental health

Primary health care

Medication assistance

Personal care

Homemaker assistance

Health screening

Health education

Exercise and fitness

Congregate meals

Transportation

Social activities

11

Findings

• Presence of service coordinator associated with decreased

odds of hospital stay

– Supports previous research indicating positive effects of role

– Policy implications: potentially valuable role in health reform for

vulnerable older adults

• Other findings less clear

– Health education associated with increased ED visits

– Mental health associated with increased odds of hospital visit

– Medication management associated with lower Medicaid

payments

• Additional research needed on actual utilization of services

and exposure to services over time

Affordable Senior Housing Opportunities

Collaboration

• Networking and Advocacy

• Private funders and non-profits

• LeadingAge (state and National)

Helping people is the solution, not the

problem.

Housing and Healthcare Partnerships

Resources

• http://www.leadingage.org/Center_for_Housi

ng_Plus_Services.aspx

• https://www.youtube.com/watch?v=FqGvbAr

aQxk&feature=em-subs_digest

• http://www.leadingage.org/Affordable_Senior

_Housing_Plus_Services_Program_Slows_Gro

wth_in_Medicare_Costs.aspx

12

Contact Information

Colleen Bloom

LeadingAgeDirector, Housing Operations

cbloom@leadingage.org

(202) 508-9483