4.12 serving the aging and medically frail homeless population (graf)
DESCRIPTION
Housing and serving elderly or medically frail homeless people means addressing their high health care and home care needs. It requires the design and use of service and housing models that are different from those used for most other homeless people. Providers of services to these populations present the most effective service and housing models and discuss the challenges they have overcome to end homelessness for this growing, high need population.TRANSCRIPT
Housing the Elderly Homeless
The Mercy Housing experience at
Mission Creek Senior Community
NAEH ConferenceJuly 13, 2010
Jane Graf President, Mercy Housing Ca
LIVE IN HOPE
LIVE IN HOPE
To create stable, vibrant and healthy communities by developing, financing and operating affordable, program-enriched housing for families, seniors and people with special needs who lack the economic resources to access quality, safe housing opportunities.
Founded in 1981 by the Sisters of Mercy, Omaha
Mission
LIVE IN HOPE
Housing Developmentparticipated in the development, preservation and/or financing of more than 37,200 affordable homes serving more than 128,000 people
Property ManagementManages 16,132 apartment homes 236 Mercy Housing properties37 properties managed for other non-profitsStaff in 17 statesOperate in 5 major markets nationwide
Major Activities
Mission Creek
139 one bedroom apartments for frail & formerly homeless elderlyOpened March, 2006
LIVE IN HOPE
Funding & Partners11,340,429 San Francisco Redevelopment Deferred loan13,092,518 National Equity Fund – equity on 4% LIHTC 1,000,000 San Francisco Redevelopment – HOPWA 360,000 San Francisco Redevelopment – CDBG 451,069 SFRA-Hazardous Materials Loan 7,500,000 State MHP-Residential and nonresidential 8,017,513 Citibank-bonds 625,500 AHP with BofA 396,472 GP Equity & Early Occupancy income 100,000 Northern California Community Loan Fund Grant$42,883,501 total sources
Cost: $42,883,501 Per square foot: $246 Per unit: $306,610Total Bldg size: 166,295 square feetTotal Commercial: ADHC: 6,198 Square feet; retail: 3,936
square feetLibrary: 7,449 square feet in a condo – not in dev cost
LIVE IN HOPE
88 units serve <50% AMI = $39,600/annual income max• $1,353/month/unit = contract rent• Project based Sec 8 rent subsidized; residents pay
30% of income – referred by the SF Housing Authority
51 units serving formerly homeless• < 20% AMI= $15,840/annual income max• $969/month/unit
• DPH subsidy = $592/month; resident = $377/mo
• Residents are formerly homeless referred through DPH
Rents
LIVE IN HOPE
Courtyard
LIVE IN HOPE
Resident activities
Ti Chi
Group meetings
LIVE IN HOPE
Resident activities
Halloween
LIVE IN HOPE
Resident activities
4th of July Celebration
LIVE IN HOPE
Unit Plan
LIVE IN HOPE
Typical Unit
LIVE IN HOPE
Philz Coffee Shop
Mission Creek retail
LIVE IN HOPE
• The San Francisco Library has a branch on-site which serves the community and is widely used by the residents
• Mercy Housing developed the space for the library which owns it as a condo
Mission Creek Public Library Branch
LIVE IN HOPE
• 3FTE service staff as part of property management staff• 2FTE Service staff; 1FTE Activities staff
• Full service Adult Day Health Center on site provided by Stepping Stones – medicaid eligible – 35 – 40 residents attend ADHC from Mission Creek Community
• In Home Support Services as needed – medicaid eligible – 50% of units receive IHSS support
• Case management provided by numerous agencies
• Meals on Wheels meals as needed• 51 DPH units set aside for formerly homeless
Service Staffing
LIVE IN HOPE
Services & FundingBasic Services provided Funding Source
Dedicated services staff Rents and HUD subsidies
Adult Day Health Services Medicaid, Dept Public Health, & private pay (sliding scale)
In Home Support Services Medicaid
Case management Medicaid, Dept. Public Health
Meals Medicaid, County, private
Health services/visiting nurseor Dr. hours SF Dept. of Public Health
Wellness promotion Self funded or City contract Substance Abuse support through other nonprofit Money Management organizations
LIVE IN HOPE
• Of the 51 DPH homeless residents after 3 years:– 78% still housed – 3 evictions; 3 to
higher level care; 5 deaths– Average reduction of $29,000 per
person/per year in Medical/Medicare reimbursed services
Findings from DPH Study
LIVE IN HOPE
LIVE IN HOPE
• Advocacy efforts pushed the City of SF to start funding housing and services for homeless elders in 2005
• SF policy is that all housing supported by City funds will have a 20% set aside for the homeless
• Support is through City/County General Funds– $400 to $700 per unit/per month rent subsidy– $400/per resident service funding
• City manages wait list for homeless residents and assures services
• City loan committee that manages all City funding of affordable housing includes representation from:– Redevelopment Agency– Mayors Office of Housing– Department of Public Health– Department of Human Services
Reflections: public agency point of view
LIVE IN HOPE
• Age criteria lowered to 55 to account for the advanced aging of homeless individuals
• Direct Observation Therapy – aka medication management – is an essential component to success
• Nursing hours are essential – for every 75 to 100 units of housing – not less than ½ day of nurse availability 2 to 3 times per week
• All homeless residents in the program have access to a city owned health clinic (FQHC) that provides psychiatric and primary care
• Rigorous conferencing on the needs of residents with medical personnel & the housing provider is essential to success
Reflections: public agency (cont.)
LIVE IN HOPE
• When the formerly homeless residents entered Mission Creek, highly skilled service staff needed to be available 7 days per week 12 hours per day– Constant attention needed to make the transition from the street– Needed help learning to cook/use appliances/basic things– Sounds indoors were foreign and caused alarm and fear
• After 4 years, many formerly homeless residents remain isolated by choice – pro-active outreach is essential
• Formerly homeless residents require a high level of patience from staff – continued meeting to deal with their concerns and willingness to go the extra mile to maintain them in housing
• Site staff must have more than property management skills – they must have a commitment to services & the flexibility required to assure residents maintain their housing
Reflections from a houser
Some lessons learned• Don’t assume people will take the services offered
• Money management to assure payment of rent is vital to maintaining the seniors in their housing
• Property management team experience and education is pivotal to success
• People seem to work harder to maintain their housing based on the beauty of their environment
• Partners with like minded vision is essential
LIVE IN HOPE