Housing Policy Academy

Housing Policy AcademyHousing Policy Academy

Creating Inclusive Accessible Communities for AllCreating Inclusive Accessible Communities for All

Rita M. LandgrafRita M. LandgrafCabinet SecretaryCabinet Secretary

Department of Health and Social ServicesDepartment of Health and Social ServicesWednesday, February 16, 2011Wednesday, February 16, 2011

DHSS ServicesDHSS Services

Must facilitate and empower individuals and Must facilitate and empower individuals and communities to gain healthy outcomes, both incommunities to gain healthy outcomes, both inphysical wellness and emotional well being; to gainphysical wellness and emotional well being; to gaineconomic self sufficiency, which will eliminate oreconomic self sufficiency, which will eliminate orlimit long term reliance on government, and tolimit long term reliance on government, and toprotect and support those citizens most vulnerableprotect and support those citizens most vulnerabledue to advanced age, disabilities, and producedue to advanced age, disabilities, and producepositive outcomes for the individuals we servepositive outcomes for the individuals we serve

The Aging DemographicsThe Aging Demographics

““Senior Americans, whether rich, poor, or somewhere in the middle, Senior Americans, whether rich, poor, or somewhere in the middle, face many barriers to an old age in which very basic human desires face many barriers to an old age in which very basic human desires for physical safety, appropriate health care, and maximal for physical safety, appropriate health care, and maximal independence are met. For some, crucial family supports will independence are met. For some, crucial family supports will disappear as they outlive spouses or children move to distant disappear as they outlive spouses or children move to distant places. For others, limited resources will prevent them from places. For others, limited resources will prevent them from identifying and purchasing needed services. Many will lose their identifying and purchasing needed services. Many will lose their homes—long a symbol of their independence—due to rising homes—long a symbol of their independence—due to rising property taxes and maintenance costs. Living alone, isolated from property taxes and maintenance costs. Living alone, isolated from services and perhaps coping with disabilities that prevent social services and perhaps coping with disabilities that prevent social interactions, a large and growing number of seniors will face triple interactions, a large and growing number of seniors will face triple jeopardy: inadequate income, declining health and mobility, and jeopardy: inadequate income, declining health and mobility, and growing isolation.”growing isolation.”

-Executive Summary, A Quiet Crisis in America-Executive Summary, A Quiet Crisis in AmericaA Report to Congress by the Commission on A Report to Congress by the Commission on Affordable Housing and Health Facility Needs Affordable Housing and Health Facility Needs for Seniors in the 21st Centuryfor Seniors in the 21st Century

Demographic Makeup of Demographic Makeup of DelawareDelaware

Delaware’s population of those age 65 and over will increase by Delaware’s population of those age 65 and over will increase by almost 106% between 2005 – 2030… an increase of 123,000 almost 106% between 2005 – 2030… an increase of 123,000 peoplepeople

87,000 one-person households in Delaware, most of them older 87,000 one-person households in Delaware, most of them older citizenscitizens

Majority of individuals report a strong preference to receive care in Majority of individuals report a strong preference to receive care in home or community as opposed to in facility-based carehome or community as opposed to in facility-based care

Greater community capacity to deal with cardiac, oncology, Greater community capacity to deal with cardiac, oncology, rehabilitation, and geriatric treatmentrehabilitation, and geriatric treatment

Individuals with DisabilitiesIndividuals with Disabilities

June 1999 U.S. Supreme Court rendered June 1999 U.S. Supreme Court rendered historic decision in historic decision in Olmstead v. L.C., 527 Olmstead v. L.C., 527 U.S. 581 –encouraging States to develop U.S. 581 –encouraging States to develop plans to ensure promotion of community plans to ensure promotion of community integration for individuals with disabilities integration for individuals with disabilities rather than unnecessary rather than unnecessary institutionalizationinstitutionalization

Market DrivenMarket Driven

An AARP study found that over 80% of seniors would prefer to stay in their current An AARP study found that over 80% of seniors would prefer to stay in their current dwelling and never leave to receive care. 1/3 of people 75+ live alone, with no one dwelling and never leave to receive care. 1/3 of people 75+ live alone, with no one to help with daily activities. These people are most likely to need an institution to to help with daily activities. These people are most likely to need an institution to facilitate their long term care needs. facilitate their long term care needs.

-The Road Ahead, p. 68-The Road Ahead, p. 68

74% of people said they’d prefer to receive long term care in their homes 74% of people said they’d prefer to receive long term care in their homes compared to 3% who would prefer a nursing home, or 19% in assisted livingcompared to 3% who would prefer a nursing home, or 19% in assisted living

- The Road Ahead, p. 14- The Road Ahead, p. 14

In the US, 34 million caregivers age 18 and older were providing unpaid care to In the US, 34 million caregivers age 18 and older were providing unpaid care to friends and family at any given time in 2007.friends and family at any given time in 2007.

The estimated economic value of the 34 million caregivers was $375 billion in The estimated economic value of the 34 million caregivers was $375 billion in 2007—an amount that exceeds Medicaid LTC spending in all states.2007—an amount that exceeds Medicaid LTC spending in all states.

-Across the States 2009, p. 5-Across the States 2009, p. 5

Small State – High Small State – High Institutionalized PopulationInstitutionalized Population

Focus of Center for Medicaid/ Medicare Focus of Center for Medicaid/ Medicare ServicesServices

Focus of United States Department of Focus of United States Department of JusticeJustice

Over –reliance of facility based services Over –reliance of facility based services

DHSS Commitment – Assessments of All DHSS Commitment – Assessments of All in Our Direct Care and Diversionsin Our Direct Care and Diversions

Community Wide Needs AssessmentCommunity Wide Needs Assessment

The Need for ActionThe Need for Action

The rate of growth of older Delawareans will increase at an even The rate of growth of older Delawareans will increase at an even greater pace then the general population - greater pace then the general population -

Delaware population of those age 65 and over will increase by almost Delaware population of those age 65 and over will increase by almost 106% between 2005 – 2030106% between 2005 – 2030An increase of 123,000 peopleAn increase of 123,000 people

-Delaware Facing Forward, p. 8-Delaware Facing Forward, p. 8

Delaware not only has to adjust for its current aging population, but Delaware not only has to adjust for its current aging population, but there has been an in-migration of senior citizens.there has been an in-migration of senior citizens.Between 1995 and 2000, 2,679 additional seniors 65+ moved to Between 1995 and 2000, 2,679 additional seniors 65+ moved to

Delaware according to the Census Bureau, which is about 25 Delaware according to the Census Bureau, which is about 25 new residents for every 1,000 current residents. new residents for every 1,000 current residents.


Barriers to CommunityBarriers to Community

Lack of affordable, accessible housingLack of affordable, accessible housing

Access to transportation (Research Access to transportation (Research estimates that a 75 year old woman is estimates that a 75 year old woman is likely to experience 10 years of non-driving likely to experience 10 years of non-driving and a man, six years)and a man, six years)

Limited medical infrastructureLimited medical infrastructure

Limited opportunities for engagement – Limited opportunities for engagement – usefulness is a major contributor to vibrant usefulness is a major contributor to vibrant healthhealth

Housing ConsiderationsHousing Considerations

The most significant issues seniors face can be helped by home modification and The most significant issues seniors face can be helped by home modification and assistive technology are: getting in and out of the house, walking up and down stairs, assistive technology are: getting in and out of the house, walking up and down stairs, and safely using the bathroom. and safely using the bathroom.

- A Quiet Crisis, p. 68- A Quiet Crisis, p. 68

“…“…it is projected that by 2020 there will be 4.3 million seniors with ADL limitations, it is projected that by 2020 there will be 4.3 million seniors with ADL limitations,

One-third of people age 75+ live alone, which means that there is no one in the One-third of people age 75+ live alone, which means that there is no one in the household to provide assistance if they need help with daily activities. People living household to provide assistance if they need help with daily activities. People living alone are more likely to have to move to a care facility if they need long term care. alone are more likely to have to move to a care facility if they need long term care.

More than four out of ten people age 65+ have one or more of the following More than four out of ten people age 65+ have one or more of the following disabilities that affects their ability to accomplish common tasks of everyday living: disabilities that affects their ability to accomplish common tasks of everyday living: sensory, physical, mobility, self-care, and cognitive/mental. By 2010 13% of people sensory, physical, mobility, self-care, and cognitive/mental. By 2010 13% of people age 65+ are projected to have Alzheimer’s Disease.age 65+ are projected to have Alzheimer’s Disease.

- Across the States 2009, p. 4- Across the States 2009, p. 4

Housing ConsiderationsHousing ConsiderationsAlmost half of seniors are likely to have low-income, with about 1/3 Almost half of seniors are likely to have low-income, with about 1/3

paying more than half their income toward housing. paying more than half their income toward housing. - A Quiet Crisis, p. 14- A Quiet Crisis, p. 14

By 2020, more than 80% of senior householders will be homeowners. By 2020, more than 80% of senior householders will be homeowners. Almost 44% of senior householders will be 75+. Almost 44% of senior householders will be 75+.

– – A Quiet Crisis, p.22A Quiet Crisis, p.22

About 12% of seniors claim their home is “not well” or “not well at all” About 12% of seniors claim their home is “not well” or “not well at all” able to meet their physical needs as they grow older. able to meet their physical needs as they grow older.

- Beyond 50, p. 53- Beyond 50, p. 53

Almost 1/5 of Delawareans surveyed report that they need to make Almost 1/5 of Delawareans surveyed report that they need to make major repairs, modifications, or changes to their homes to stay in major repairs, modifications, or changes to their homes to stay in them as they age.them as they age.


Universal DesignUniversal Design – housing features that enable people of all ages to – housing features that enable people of all ages to efficiently live in their home. Examples of Universal Design efficiently live in their home. Examples of Universal Design elements in a home include wider door ways, lower counter tops, elements in a home include wider door ways, lower counter tops, and grab bars to assist individuals in the bathroom and shower. and grab bars to assist individuals in the bathroom and shower.

-Beyond 50, p. 56-Beyond 50, p. 56

The most frequently needed modifications are faucet and cabinet The most frequently needed modifications are faucet and cabinet adaptations, stair lifts or elevators, bathroom access, ramps, and adaptations, stair lifts or elevators, bathroom access, ramps, and curbless or roll-in showers curbless or roll-in showers

--A Quiet Crisis, p. 68A Quiet Crisis, p. 68

Approximately 20% of those surveyed by AARP in Delaware, claim to Approximately 20% of those surveyed by AARP in Delaware, claim to need major modifications to their homes in order to be able to stay need major modifications to their homes in order to be able to stay there as they age. Of this people 66% claim to need bathroom there as they age. Of this people 66% claim to need bathroom modifications such as grab bars and handrails, 59% need access to modifications such as grab bars and handrails, 59% need access to accommodations such as ramps and chairlifts, 43% need a new roof accommodations such as ramps and chairlifts, 43% need a new roof or new plumbing, 38% need better cooling for summer, and 36% or new plumbing, 38% need better cooling for summer, and 36% need better heating. need better heating.

––The Road Ahead (non-truncated The Road Ahead (non-truncated version), p. 10version), p. 10

Health and Wellness BenefitsHealth and Wellness Benefits

Research shows that continuing to develop and maintain Research shows that continuing to develop and maintain social ties is associated with better physical and mental social ties is associated with better physical and mental health among people of all ageshealth among people of all ages– Enhances self esteem and personal controlEnhances self esteem and personal control– Helping others generate positive emotions such as Helping others generate positive emotions such as

satisfaction and pridesatisfaction and pride

Boosts immune functioningBoosts immune functioning

Social and intellectual stimulation helps fight cognitive Social and intellectual stimulation helps fight cognitive declinedecline

Paying for Long Term CarePaying for Long Term Care

It is estimated that a senior would need a min. of $100,000-$250,000, It is estimated that a senior would need a min. of $100,000-$250,000, with an annual 3 percent yield, at age 65 to cover future long term with an annual 3 percent yield, at age 65 to cover future long term care expenses. care expenses.

In 2000, only 18% of the senior citizens most likely to use nursing In 2000, only 18% of the senior citizens most likely to use nursing home care had sufficient financial resources to cover 2.5 years in a home care had sufficient financial resources to cover 2.5 years in a nursing home. nursing home.

Home equity loans and reverse mortgages to fund home remodeling Home equity loans and reverse mortgages to fund home remodeling projects or to pay for expenses like medical care, basic needs, projects or to pay for expenses like medical care, basic needs, and/or taxes- and/or taxes-

-Delaware Facing Forward, p. 21, -Delaware Facing Forward, p. 21, 2424

Nationally, per capita health care expenditures and spending on Nationally, per capita health care expenditures and spending on nursing home and home health are projected to increase by more nursing home and home health are projected to increase by more than 170% by 2015.than 170% by 2015.

According to the U.S. administration on Aging, for Delaware this means According to the U.S. administration on Aging, for Delaware this means an increase from $5.8 billion in 2005 to $7.25 billion in 2030 an increase from $5.8 billion in 2005 to $7.25 billion in 2030


In an AARP survey of Delaware residents 35+, 50% of the In an AARP survey of Delaware residents 35+, 50% of the participants had little to no confidence in their ability to participants had little to no confidence in their ability to pay for long term care services for themselves or a pay for long term care services for themselves or a family member. family member.

About 40% plan to rely on government programs and about About 40% plan to rely on government programs and about 30% plan to use long-term care insurance. 30% plan to use long-term care insurance.

While an average year in a nursing home is about $81,000, While an average year in a nursing home is about $81,000, there is hope for reduced expenses in at-home care. An there is hope for reduced expenses in at-home care. An average of 2 hours of daily home care cost about average of 2 hours of daily home care cost about $15,000 per year. $15,000 per year.


In 2003, Medicaid paid for 46% of all nursing home expenditures, with In 2003, Medicaid paid for 46% of all nursing home expenditures, with an additional 12% paid for by Medicare. an additional 12% paid for by Medicare.

While Medicare is the largest single payer for home care services, While Medicare is the largest single payer for home care services, more than 1/3 of Medicaid funds now go to finance long-term care, more than 1/3 of Medicaid funds now go to finance long-term care, which will reach half of all Medicaid spending by 2015, according to which will reach half of all Medicaid spending by 2015, according to CMS, the federal agency responsible for the Medicaid program.CMS, the federal agency responsible for the Medicaid program.

––Unsettling the Scores, p.27Unsettling the Scores, p.27

Since not everyone qualifies for Medicaid, many will have to resort to Since not everyone qualifies for Medicaid, many will have to resort to other options when their finances fall short. Some will use home other options when their finances fall short. Some will use home equity to finance improvements, accommodations, or relocations. equity to finance improvements, accommodations, or relocations. Because long-term care is so expensive, 56% of nursing home Because long-term care is so expensive, 56% of nursing home residents eventually “spend down” their resources and qualify for residents eventually “spend down” their resources and qualify for help from Medicaid anyways only perpetuating the problem. help from Medicaid anyways only perpetuating the problem.

-Unsettling the Scores, p. 27-Unsettling the Scores, p. 27

Major Initiatives and FocusMajor Initiatives and Focus

Building a Continuum of LTC SupportBuilding a Continuum of LTC SupportAffordable Health Care Act Affordable Health Care Act Focus on Olmstead – CMS & USDOJFocus on Olmstead – CMS & USDOJConverting to a Needs Based Budgeting Converting to a Needs Based Budgeting Process and Prioritization Process and Prioritization Building a seamless system of supports – Building a seamless system of supports – across across government, within DHSS and with our government, within DHSS and with our partnerspartners

AdvancingAdvancing Opportunities Together Opportunities Together

– Development of alternative models resulting Development of alternative models resulting in greater use of community networks and in greater use of community networks and servicesservices

– Meeting the needs of an ever growing Meeting the needs of an ever growing population while expanding inclusionary population while expanding inclusionary opportunitiesopportunities

– Creative utilization of resources to support Creative utilization of resources to support need and leverage community resourcesneed and leverage community resources

Inclusive CommunitiesInclusive Communities

– Affordable, accessible, walkable mixed use Affordable, accessible, walkable mixed use community housingcommunity housing

– Create commercial opportunities both in health, Create commercial opportunities both in health, nutrition, exercise, job developmentnutrition, exercise, job development

(the average working American family spends nearly (the average working American family spends nearly 60% of their budget on housing and transportation 60% of their budget on housing and transportation costs)costs)

Delaware Focused ActivitiesDelaware Focused Activities

Governor Markell’s agenda - commitment Governor Markell’s agenda - commitment to community based enhancementsto community based enhancements

Governor’s Institute on Community DesignGovernor’s Institute on Community Design– Cross Cabinet CollaborationCross Cabinet Collaboration

Affordable Care Act opportunitiesAffordable Care Act opportunities

Commission Dedicated to Community Commission Dedicated to Community Based AlternativesBased Alternatives

Aging and Disability Resource CentersAging and Disability Resource Centers

Value EngagementValue Engagement

Housing, Social Service Providers and Housing, Social Service Providers and Consumers as Partners Consumers as Partners

Housing, Social Service Providers and Housing, Social Service Providers and Consumers as Advocates for Systemic ReformConsumers as Advocates for Systemic Reform

Housing, Social Service Providers and Housing, Social Service Providers and Consumers as Conveners to Bring Leadership, Consumers as Conveners to Bring Leadership, Policymakers, and Stakeholders together to Policymakers, and Stakeholders together to Embrace the Vision and Create Path ForwardEmbrace the Vision and Create Path Forward

ConclusionConclusion

““This “Big Squeeze” poses a serious challenge to Delaware’s future. This “Big Squeeze” poses a serious challenge to Delaware’s future. Large-scale demographic changes are coming to our state—Large-scale demographic changes are coming to our state—changes over which we will have little control. For the most part, changes over which we will have little control. For the most part, these changes are to be welcomed. We are living longer, becoming these changes are to be welcomed. We are living longer, becoming more diverse, and present a more and more appealing lifestyle that more diverse, and present a more and more appealing lifestyle that is attracting others to Delaware…is attracting others to Delaware…

……that’s why anticipating these challenges and being proactive in that’s why anticipating these challenges and being proactive in dealing with them are so important.” dealing with them are so important.”

- Delaware Facing Forward, p. 42- Delaware Facing Forward, p. 42

Your Turn

Housing Policy Academy

Documents

Transcript of Housing Policy Academy