Sustainable Community Living Option to Support Transition ...€¦ · Sustainable Community Living...

Sustainable Community Living Option to

Support Transition and Prevent

Institutionalization

Candace BaldwinNCB Capital Impact

Diane DresslerMaryland Center for Developmental

Disabilities - Kennedy Krieger Institute

Leyla SarigolDC Dept of Health Care Finance

Robin WagnerLA Office of Aging and Adult Services

Agenda

• Introduction of Panelists

• Discussion Points– Community Living Options are necessary for the successful

implementation and sustainability of home and community based programs

– Programmatic and policy opportunities are available to create systems change for transition and diversion

– Cross agency collaboration, local partnerships and comprehensive strategy are key

– States have developed innovative programs to support and expand community living

• Open Discussion

It Takes More Than Money to Spark Lasting Economic Progress

• Empowering communities through

– Innovative community lending– Expert technical assistance– Effective policy development

• Key areas of work include

– Affordable cooperative housing– Cooperative service purchasing arrangements– Community-based and facility-based LTSS enhancement– Community-based health and behavioral care– Educational Facilities

Connecting Long Term Supports Policy with Real World Practices

• Center for Long Term Supports Innovation:– Mission to help older Americans and

people with disabilities to conduct their lives with maximum independence, dignity and connection to their communities

– Provide innovative, expert technical assistance to community-based organizations working in underserved and moderate- and low-income communities

Community Integration is More Than Just Physical Presence in the Community

• Comprehensive community integration programs need to include housing, education, employment, transportation and personal care services

• Planning for these programs are conducted at local levels

• Transparency in communication among multiple agencies is key

The Current Housing Environment is Volatile

Housing Environment Implications

Current state of the credit market Financing for affordable housing very tight, investors more risk adverse, cost of development is more expensive

State HFAs are balancing wide variety of housing needs

Maximizing spread of limited housing funds, localities must create gap financing, family housing competes with affordable/accessible housing needs

Homeownership declining due to subprime lending market fallout

Affordable rental units will be taken by families; loss of supply; decline in condo market could result in expanded multifamily rental supply

Aging out of Housing Subsidies Loss of critical mass of affordable rental units, lack of rental housing, subsidies not serving very low income

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Community Living Includes a Wide Array of Housing Models

Permanent SupportiveHousing

Shared Housing

Accessible, affordable and integrated rental

Adult Family Homes

Cooperative Homeownership

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Housing Support Programs Require Cross Sector, Cross Disability Collaborations

• Coalition of agencies to define mission, vision and key objectives

• Assess commonalities in similar housing for people needing some level of service coordination

• Dedicated staff person at the executive level to liaison cross systems

• Partner with legislative committees to foster cross system collaborations

Locally Based Strategies are Key to Community Living

• Public Housing Authorities • Public Housing units• Rental Assistance

• State Housing Finance Agencies• Housing Trust Funds – in large metro areas are managed by

local government• Low Income Housing Tax Credits• Tax Exempt Bonds

• Local Housing/Community Development Agencies• Participating Jurisdictions (HOME, CDBG, Rural Development)• Dedicated and unique housing finance programs• Transportation, ADRCs, CILs and others

Building Local Partnerships can Enhance Ability to Coordinate an Approach

• Public Housing Authorities –• Raise knowledge of PHA staff to understand needs and

preferences of MFP participants• Assess local housing needs and develop strategies to

address future plans and planning processes• Work with PHA to identify resources for housing

development and tenant based rental assistance

• Mission driven, affordable housing developers• Tend to have local service areas • Examples: Faith based organizations, Community

Development Corporations, coalitions/association of non profit developers

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Create Living Options and Community Based Infrastructure Long Term

• Changes to existing housing finance programs and development of finance packaging will result in units long term (3-5 years)

• Focus on creating sustainable infrastructure for housing and services

• Long term strategies will be useful to sustain affordable, accessible and integrated housing for individuals with disabilities not served by the MFP Initiative

Opportunities on Horizon Provide Key Components

• Community Living Initiative– HUD and HHS – collaborating and assessing

intersection points

• Section 811 – New way to create unit mass

• Affordable Care Act– Emphasizes focus on HCBS– Encourages innovative strategies

Question & Answers

For More Information Candace Baldwin

Senior Policy AdvisorNCB Capital Impact

Center for Excellence in Long-Term Supports [email protected]

(703) 647-2352www.ncbcapitalimpact.org

Community Based Housing for People Transitioning from Institutions Through MFPChronology & Lessons from DC2008-2011+

Leylâ Sarıgöl, Project Director, DC Money Follows the Person Rebalancing DemonstrationNASUAD/HCBS 2011 National Home & Community Based Services ConferenceSeptember 13, 2011

Department of Health Care FinanceGovernment of the District of Columbia

For Official Government Use Only

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Government of the District of Columbia Department of Health Care Finance


Housing for DC’s MFP Rebalancing Demonstration: Chronology

MFP Target Group Housing FinancingYearI/DD EPD MH DD Local Funds Housing Choice

VouchersDCHA Public

HousingAlternative

Sources (811,HOME. etc)

2008 X X2009 x X2010 x X2011 x x X X2012 x x x x X X2013 X X X X X X2014+ X X X X X

COMMUNITY BASED HOUSING

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Housing for DC’s MFP Rebalancing Demonstration: LessonsLESSON 1: All politics are local. Control is local.– ADVICE: Get support at the highest level & at the grassroots level early & often.

LESSON 2: Communication & trust are keys to success.– ADVICE: Know the right people & talk to them at the right time.

LESSON 3: You have to focus on housing. Get information & follow up.– ADVICE: Dedicate human & financial capital to housing coordination.


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Housing for DC’s MFP Rebalancing Demonstration: Lesson 1LESSON 1: All politics are local. Control is local.

ADVICE: Get support at the highest level & at the grassroots level early & often.

Mayor

City AdministratorHousing Authority

BoardCity Council

Advocacy Groups


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Housing for DC’s MFP Rebalancing Demonstration: Lesson 1LESSON 1: All politics are local. Control is local.ADVICE: Get support at the highest level & at the grassroots level early & often.

Mayor, City Council, DDS/DDA Local funding for housing

Mayor, Advocates Set-aside of Long-Term Care Housing Choice Vouchers

City Administrator’s Office Interagency collaboration

Mayor Cease & desist use of MFP HCV set-aside

Mayor, DCHA Board Opportunity to get MFP HCV set-aside back

Advocates Olmstead Litigation

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Housing for DC’s MFP Rebalancing Demonstration: Lesson 2

LESSON 2: Communication & trust are keys to success.

ADVICE: Know the right people & talk to them at the right time.

DC Office of Planning

DCOA/ADRCDHS PSH

Developers/Property Managers


Housing Authority

Operations

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Housing for DC’s MFP Rebalancing Demonstration: Lesson 2Lesson #2: Communication & trust are keys to success.Advice: Know the right people & talk to them at the right time.

Office of Planning Where is accessible housing? How do we get it?

Housing Authority Operations • Access to voucher/market units & public housing• Weekly coordinating call• NEPD voucher application & award allocation• Action to hold onto MFP voucher set-aside

Office on Aging/ADRC • Exchange: LTC Vouchers• MFP/ADRC $

Dept. of Human Services/PSH • Exchange: Training, Client Aid• Key Information

Developers/Property Managers • Opportunities to request & hold units to spec• Negotiations for special circumstances-timeline

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Housing for DC’s MFP Rebalancing Demonstration: Lesson 3LESSON 3: You have to focus on housing. Get information & follow up.

ADVICE: Dedicate human & financial capital to housing coordination.

Housing Consultant

Transition

CoordinatorsHousing Specialist

Advocacy Groups


Project Manager

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Housing for DC’s MFP Rebalancing Demonstration: Lesson 3LESSON 3: You have to focus on housing. Get information & follow up.ADVICE: Dedicate human & financial capital to housing coordination.

Project DirectorArticulate vision & strategy to secure & maintain resources. The Glue!

Connect project to local resources & advocate to keep them

Advocates Local housing opportunities - especially accessible housing

Transition Coordinators Connect individuals to appropriate resources through transition Complete applications, coordinate logistics for individuals

Housing Consultant Connect project to promising national strategies.Provide guidance & manpower to implement strategies

Housing Specialist Maintain relationships with developers, property managers. Maintain pool of housing, identify units for participants. Transition services: household set-up, inspection

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Housing for DC’s MFP Rebalancing Demonstration: Contact

Leylâ Sarıgöl, Project Director

DC Money Follows the Person Rebalancing Demonstration

202.442.5918 office

[email protected]

Division of Long Term Care

District of Columbia Department of Health Care Finance

899 N. Captiol Street NE, 6th Floor

Washington, DC 20002

www.kennedykrieger.org

Maryland Housing Partnerships

Diane DresslerProgram Director, Training and

Services for AdultsMaryland Center for

Developmental Disabilities

www.kennedykrieger.org26

Creating Affordable Housing for People with Disabilities

DD Council

Dept. of Housing & Community Development

DHMH: MedicaidDept. of Disabilities

Developmental Disabilities Admin.

Mental Hygiene Admin.

HUD: Baltimore Field Office

MD Assn. of Housing & Redevelopment Agencies

Centers for Independent Living

The Coordinating Center

MD Affordable Housing CoalitionOn Our Own

of MD

People on the Go

MD MFP

MD Disability Law Center

The Partners

MD Center for Developmental Disabilities


The Beginning…Partnerships to Create Resources

• 2001: Olmstead Housing Task Force– Accomplishments

• QAP set aside: 10%• Housing and Disability Services Resource Guide• Cross-training • Relationship with PHAs

• 2003: Governor’s Commission on Housing Policy– Special Needs Housing Subcommittee

• Bridge Subsidy Demonstration Program

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2007:Bridge Subsidy Demonstration Program

• MOU between State Housing Agency (SHA), State Health Dept., CILs and certain PHAs

• Funded by SHA revenue

• Tenant Based Rental Assistance for up to 3 yrs. –tenant pays 30% income for rent + utility allowance

• Participant receives Housing Choice Voucher

• Eligibility– Adult– SSI cash payment– Income below $15,000– Individualized service plan

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• Outcomes:– 110 people with disabilities received rental assistance

– 77 participants to date have transitioned to a Housing Choice Voucher (Section 8)

– Developed tenant training program

– Developed collaborative process for program implementation

– Acquired statutory authority to implement a permanent Bridge program

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2007:Bridge Subsidy Demonstration Program


• Infrastructure from Bridge Subsidy Demonstration Program, with these changes– Rental assistance for 5 years– Administrative fees to PHAs

• Funding = $1 million DDA/MFP rebalancing funds

• Priority populations – Transitioning from institutions– Transitioning from group homes– Homeless and at risk for institutionalization

• Outcome– 20 participants have received the subsidy

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2010:DDA/MFP Bridge Subsidy Program


2010: Vouchers for Non-Elderly Disabled

Applications

• 11 PHAs applied for Category 1 and 2 vouchers

• Support letters and service system information from partnering disability organizations

Awards

• Category 1: 260 statewide– Montgomery County = 160– Carroll County = 100

• Category 2: 112– Baltimore County = 50– Baltimore City = 40– DHCD = 12– Howard County = 10

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• MOU: Partnership between The Weinberg Foundation, DHCD and DHMH– Facilitated by MD Department of Disabilities

• $1million for capital costs of DHCD funded development– Units affordable at 15-30% AMI– Affordable for 40 years

• Weinberg approves units & provides funds to DHCD

• DHCD disburses funds and monitors compliance

• DHMH refers qualified tenants– Tenant pays 30% income for rent

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2011: Weinberg Apartments


• Formed in April 2011 by MD Dept. of Disabilities– Broad base of partnering organizations

• Preparing for HUD 811 NOFA – Fall 2011?– HUD 811 revised in 2010 to expand impact by providing

Project Rental Assistance (PRA)– Affordable housing at SSI level of income

• Need to create infrastructure to implement PRA– Partnership between SHA and Medicaid– Consumer involvement– Tenant eligibility and referral mechanism– Unit identification on initial lease-up and turn-over– Training for housing and disability organizations

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2011:HUD 811 Steering Committee


Building Partnerships

• Become informed– What housing resources exist?– How are they used?– Who administers them?

• Seek advice/technical assistance from affordable housing experts on how and where to start– NCB Capital Impact– Technical Assistance Collaborative, Inc. (TAC)– National Disability Institute– National Low Income Housing Coalition

…to name a few

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• Seek and participate in training/conferences about housing programs– HUD– Local PHA membership organization (local NAHRO affiliate)– Local housing organizations

• Offer training for housing organizations– Disability service systems– Reasonable accommodations/Section 504 compliance– MFP/Medicaid

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Building Partnerships


• Establish a statewide committee– Include broad-based stakeholder representation– Expand to local areas with statewide support

• Build knowledge & trust - Make small changes at first– Consolidated Plan– LIHTC QAP– Demonstration/pilot programs

• Support housing organizations– Crisis support for PHAs, landlords– Support letters for LIHTC projects, special needs vouchers

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Get Started


Keep Your Eyes on the Prize!

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Diane DresslerMaryland Center for Developmental Disabilities

at Kennedy Krieger Institute

7000 Tudsbury Road

Baltimore, MD 21244

443-923-9555

[email protected]

38

Contact Information

Louisiana’s Cross‐Disability Permanent Supportive Housing

(PSH) ProgramRobin Wagner

Deputy Assistant Secretary Office of Aging & Adult Services

Louisiana Department of Health & Hospitals

History & Purpose

• Leveraged from recovery effort associated with 2005 Hurricanes Katrina & Rita– Bulk of units being completed 2010‐12

Two Policy Goals:• Prevent and reduce homelessness among people with disabilities

• Prevent and reduce unnecessary institutionalization of people with disabilities

Scope

• Cross‐disability – mental health, addictive disorders, physical disabilities, developmental disabilities, & elders with disabilities

• Regional – serving only South Louisiana at this time (area affected by 2005 hurricanes)

• Units – 3,000 PSH Units – 2,000 Project Based units for all populations– 1,000 Shelter‐Plus Care units for homeless households/persons with disabilities

Key Principles

• High quality housing• Community‐integrated housing• Services to support independence and successful tenancy, but

• Services are not a condition of tenancy• Housing providers should provide housing, not services

• Service providers should provide services, not housing

Status

• Currently housing 2, 357 households (1,698 in Greater New Orleans)

• Aug 1 sample of 1,331 households:– 477 behavioral health– 137 developmental disabilities– 15 age‐related disabilities– 102 chronic illness– 173 physical disabilities– 427 households reported have member(s) with more than one type of disability

• 44 institutional transitions

Status

• Additional 1,145 receiving pre‐tenancy services

• Rental subsidies obtained for 3,248 PSH units• 98% retention rate (only 2% with negative outcome)

• 9% of N.O. households have improved income

DowntownRehab

New Construction in Mid‐City

Model – The Components

• Low Income Housing Tax Credit Program– High quality– Integrated: 5% to 15% PSH unit set‐aside

• Rental Subsidy– Project‐based Section 8 (2,000 vouchers)– Shelter‐Plus Care (1,000 vouchers)

• Services– Community Development Block Grant (to start)– Medicaid for sustainability

Model – The State Agencies

• Louisiana Housing Finance Agency– for Low Income Housing Tax Credits

• Louisiana Office of Community Development– for Community Development Block Grant $$s for services

– for administration of project‐based subsidies• La. Department of Health and Hospitals

– for referral, services delivery, and integration with Medicaid program

Model – Other Necessary Partners• Homeless Coalitions• Housing Developers• Community‐based Service Providers• Communities themselves

Outside Help:• Technical Assistance Collaborative• Melville Trust• Robert Woods Johnson• Common Ground, New York

Model – Service Delivery

• DHH‐affiliated regional entities do outreach, identify applicants, assist with application, manage wait lists, contract and monitor CDBG‐funded services

• Contracted social service agencies provide housing support teams, Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT)

• Medicaid HCBS services and Money Follows Person also come into play

Working Relationships

• To Office of Community Development: Ever hear of Medicaid?

• To Developers: You have a poor people problem, and we can help.

• To La. Housing Finance Agency Board: There’s a lot of us and we’ve got our orange stickers on.

• Between Homeless Coalitions & Disability Community: What is a home?

• To all the partners, ongoing: Good faith and delivering .…

The Future: Sustainability & Expansion

• Incorporating services into HCBS waivers, 1915 (i) for mental health, and contract for Statewide Management Organization for behavioral health

• Tightening targeting criteria slightly (over 85% currently qualify for Medicaid)

• Tied closely to MFP and institutional downsizing (preference points & streamlined referral)

• Will cost‐allocate and stretch CDBG for non‐Medicaid population

• Continuing incentives for PSH units in LIHTC program• Developer & housing provider support• Using 811 in LIHTC for statewide expansion

Issues/Lessons

•Housing subsidy is critical•Benefit of single housing entity at state level•Current battle is on the local front: NIMBY

La. Department of Health & Hospitals

Office of Aging & Adult [email protected]

225.342.3839

mailto:[email protected]

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