Affordable Housing Institute : US

How does a property become a community?  And when it has undeniably become one, should its economics change to accommodate?  These questions are poignantly illustrated by this Boston Globe story about the spontaneous community that invariably arises in all-elderly complexes, and how housing becomes a nexus for social services:

 

There’s a new sense of security and community at a Brookline apartment complex where more than 180 seniors live.

 

Rose Finkelstein, who will turn 100 next week, regularly greets visitors to one of the buildings.

 

Rose Finkelstein (left), who turns 100 next week, and Lillian Stanger have benefited from an array of services that are offered at The Village at Brookline apartment complex. (John Tlumacki/ Globe Staff)

 

Residents who previously kept to themselves gather every Tuesday to head to the supermarket together. Many drop down to the lobby to see a nurse practitioner who stops in once a week. And a social worker checks on those who haven’t been seen out and about.

 

The services and camaraderie mimic assisted-living centers, but this was never designed as a retirement community.  The Village at Brookline is a privately owned, federally subsidized apartment complex that’s part of a national movement to bring services to seniors where they live, allowing them to grow old in familiar and comfortable surroundings.

 

Three times our Federal government has sponsored all-elderly complexes:

 

• Section 202: all-elderly non-profit, cheap loans or up-front grants.
• Section 236 elderly: all-elderly regulated for-profit, cheap loans with interest reduction payments.
• Section 8 New Construction elderly: all-elderly, income subsidy supporting market-plus rents.

 

Section 202 property in Seattle

Note shuttle vans and contiguous buildings

 

Today virtually every one of these properties is still all-elderly, and as illustrated by Village at Brookline, the average resident age continues to creep up, from about 65 when the properties were developed to well over 78 today. 

 

A few determined theoretical housing economists endlessly debate the merits of demand-side (voucher) versus supply-side (production) housing programs — in my view, there’s a need for both — but here’s a fringe benefit of supply-side that demand-side cannot match: a property established as affordable can age with its resident population into something more. 

 

Here’s another: an all-elderly property becomes a nexus for services:

 

This part of the movement serves “naturally occurring retirement communities” that can form in apartment buildings, condominium complexes, and neighborhoods of private houses as residents age.

 

The communities were named by a Wisconsin professor who first noticed the trend in 1984.

 

Perhaps I could name it a naturally occurring retirement community?

 

In each community, residents help determine what health and social services they need to stay well and live independently.  

 

Independence is as much a state of mind as a physical condition, and its state of mind bestows health.

 

Just signing it makes us feel better already

 

Federal, state, and private funding subsidizes the services, which are provided by public and private agencies.

 

This is quite a challenge, because of the silo effect of Federal programs. 

 

Can’t get funding from Medicare to housing, can you?

 

Even today, for instance, Medicare (for the elderly) generally cannot pay rent, and Section 8 (for low-income households) generally cannot pay services. 

 

The programs, which are open to all members of the community regardless of income, are more comprehensive than the homemaking and home-health services the state provides to individual low-income seniors in their homes. Typically, the programs also include social and educational activities designed to reduce isolation and build community, as well as transportation, preventive care, exercise, and one-on-one help managing everyday problems.

 

Yet the best providers are often the property owners and managers, for they have ongoing familiar contact with the residents who need the services, and they maintain the property, community rooms, and common areas where services are most humanely and effectively provided.

 

Six such communities are serving more than 1,000 residents in Massachusetts, and money in the state budget will help fund several more.  Nationally, more than 80 are thriving, driven by the boom in the over-65 population.

 

The true figures are much higher, because virtually every all-elderly property in my experience provides additional services.  Indeed, in many properties (starting with Section 202’s) HUD now authorizes the property to pay of a ’service coordinator’ as a full-time staff employee whose job it is simply to bring in outside services that enhance resident quality of life. 

 

“This is one of the best ways to take care of seniors,” said Rimma Zelfand, who oversees programs in Brookline and Malden. “We do all we can to help them age well at home.”

 

The program in Brookline, which began in late 2004, rescued Lillian Stanger after her husband died early last year. At 83, she had lived in the Village for 22 years, but she barely knew her neighbors. She fought to maintain her independence as spinal arthritis and fractures from osteoporosis made it difficult for her to run errands or get groceries. Stanger slipped into depression fueled by loneliness.

 

Shoes, by van Gogh: depression follows loneliness

 

The same needs are found in public housing:

 

In Massachusetts, similar services are provided by the state through its $3.7 million supportive housing program, which operates in 22 public housing projects and will expand to eight more this fiscal year.

 

In some cases, the money is found by fiat:

 

This model grew out of a program in New York City in 1986, where privately funded services were brought into a large apartment complex. A decade later, New York state and then New York City chipped in, and the programs now include 49,000 seniors, according to the United Hospital Fund of New York, a philanthropy that researches and supports healthcare initiatives. The concept spread nationwide with $22 million earmarked by Congress.

 

One hears much criticism these days of ‘earmarks’ as if they are all pork. 

 

“Hey, it’s a lot better than a toe tag.”

 

Yet it is members of Congress who often see these needs, and act upon them:

 

In 2004, Massachusetts’ delegation secured nearly $800,000 over two years to establish pilot programs in Brookline, Malden, and Swampscott run by Jewish Family & Children’s Service and its affiliates, which already had a large home-care program serving seniors of all backgrounds.

 

Absent earmarks, how can Congress directly pilot worthy innovations?  Such pinpoint targeting would never make it through an authorization and Notice of Funds Availability (NOFA) process.

 

Fund it right here

 

In Malden, many Chinese and Russian immigrants live in the two apartment buildings in the program, so translation is a big component of the services. A social worker meets regularly with residents to help manage their medical needs.  In Swampscott, the program was established at the Summit Estates condominium complex on Route 1A, as a pilot in a middle-income community. About 75% of the condo residents are seniors.

 

Piloting also occurs at the state and local level:

 

State lawmakers included $375,000 for naturally occurring retirement communities in the budget signed by Governor Mitt Romney two weeks ago, although they have yet to pass another measure that would entitle low-income seniors on Medicaid to more free home care. The budget funds the sites in Brookline and Malden and several new locations in Framingham, one of which began last year with private money.

 

“The Legislature is interested in programs that will help people remain in their residences and provide support services in a way that enhances the quality of life,” said Representative Deborah Blumer, a Framingham Democrat, who lobbied for the funding. “It’s a lot less expensive to do that than to put people in nursing homes or other intensive, expensive settings.”

 

Ms. Blumer favors programs in place.

 

Unfortunately, as with most innovations, some are yet to be convinced:

 

Despite the successes, the federal money will run out at the end of August because fiscal conservatives in Congress blocked funding for a range of projects, including the naturally occurring retirement communities. Other members of Congress are pushing for permanent funding through the Older Americans Act, but the Bush administration has questioned whether the programs are the most efficient use of money.

 

“The concepts have a lot of potential, but people are duplicating activities,” said Frank Burns, deputy assistant secretary [for wellness and community-based services — Ed.] of the US Administration on Aging.

 

Not that Frank Burns, Hot Lips!

 

He said that similar referral and case-management services are already being provided by state and federally funded agencies and that the money would go further if spending is consolidated.

 

With all due respect to Mr. Burns, he has the question backwards: ask not what are the available channels, ask what delivery best serves the customer.

 

As our elders age, the time should come when we invert the normal approach to service delivery: instead of asking the people to go to the services, we will find it much better to bring the services to the people.

 

Paul Bunyan could find a solution.

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