Senate Joint Resolution No. 11

Introduced by Senator DeSaulnier

April 29, 2013

Senate Joint Resolution No. 11—Relative to housing with services.

LEGISLATIVE COUNSEL’S DIGEST

SJR 11, as introduced, DeSaulnier. Housing with services.

This measure would urge the President and Congress of the United States to support housing with services models to achieve federal goals of using subsidized housing as a platform for service and encourage the President and Congress of the United States to expand Sections 1115 and 1915(c) federal Medicare waivers to test and integrate services into affordable housing settings.

Fiscal committee: no.

WHEREAS, “Housing with services” is unlicensed, subsidized,
congregate properties for low-income seniors that provide access
to a range of health-related and supportive services available to
residents on a voluntary basis. Services are provided by
appropriately credentialed providers and can include care
coordination from an interdisciplinary team, resident service
coordinators, and health educators, or colocation of health services,
for example a federally qualified health center or Program of
All-Inclusive Care for the Elderly (PACE), onsite. Housing with
services can enable residents to age in place, reduce hospital and
emergency room usage, and postpone the need for costly
institutional care; and

WHEREAS, According to the California Department of Aging,
the population over 60 years of age is expected to grow more than
twice as fast as the total population. Older adults will have an
overall increase of 112 percent during the period from 1990 to
2020. California’s oldest old-age group, those over 85 years of
age, will increase at an even faster rate than older adults, having
an overall increase of 143 percent during the period from 1990 to
2020. The surge of the 85 years of age and over age group in
California is expected to emerge most strongly between 2030 and
2040, as the first of the “baby boomers” reach 85 years of age; and

WHEREAS, Ten percent of Californians over 65 years of age
live in poverty, and 21 percent live below 150 percent of the
poverty line, according to the American Community Survey. In
the United States, the percent of older Americans in poverty
increases with age, with the oldest of elderly people most likely
to be poor. Nationwide, 10 percent of persons 75 years of age and
older were considered poor, compared to 8 percent of persons 65
to 74 years of age; and

WHEREAS, Approximately 1.3 million very low income seniors
are assisted through publicly subsidized housing, very low income
being defined as less than 50 percent of the area median income.
The Section 202 Supportive Housing for the Elderly program is
the only United States Department of Housing and Urban
Development (HUD) program that currently provides housing
exclusively for elderly households, with approximately 263,000
units. In 2006, HUD reported that 38 percent of all Section 202
properties reported having a service coordinator on staff. Service
coordinators in HUD developments for elderly persons and persons
with disabilities work with residents to coordinate a wide range
of services. These include the arrangement of transportation, meal
services, housekeeping, medication management, visits from
nurses, dentists, and massage therapists, haircuts, and social
activities; and

WHEREAS, The nexus between affordable senior housing and
long-term services and supports is natural. According to HUD’s
fiscal year 2013 proposed budget, 38 percent of seniors in Section
202 properties are frail or near frail, requiring assistance with at
least three basic actives of living, such as eating, bathing,
grooming, dressing, or home management activities, and thus can
be considered at risk for premature institutionalization; and

WHEREAS, Research has also found that service-enriched
housing for the elderly, and the presence of service coordinators
in particular, enables older residents to remain in their homes
longer. A satisfaction study found that residents residing in
properties that offered service coordination had an average length
of stay that was six months longer than properties that did not offer
service coordination; and

WHEREAS, The cost of institutionalization exceeds the cost of
housing with services models. In 2004, the cost of a stay in a
nursing home funded by Medi-Cal was approximately $49,000 on
average, while the cost of Section 202 housing plus the most
frequently provided services, such as food, transportation, and
housekeeping, is estimated to cost only $13,000. If a fuller set of
personal services is provided for very frail elders, the cost of
housing plus services is estimated at approximately $25,000, about
one-half of the cost of skilled nursing care; and

WHEREAS, As stated in HUD’s fiscal year 2013 proposed
budget, it is the department’s goal to use its housing as a platform
to deliver a wide variety of services to improve the quality of life
of its residents. HUD seeks to build formal and informal
relationships with public and private healthcare providers, and
with health education organizations, to provide access to healthcare
information and services for recipients of HUD assistance. HUD’s
fiscal year 2013 proposed budget provides a total of $625 million
for the Supportive Housing for the Elderly and the Supportive
Housing for Persons with Disabilities programs, which include
$154 million to support 5,300 additional supportive housing units
to better connect residents with the supportive services they need
to age in place and live independently; and

WHEREAS, The state is directed under the Olmstead Plan to
improve its long-term care system so that its residents have
available an array of community care options that allow them to
avoid unnecessary institutionalization. The Olmstead Plan includes
goals to include services that transition individuals from
institutional settings to the most integrated settings appropriate for
their needs, including the California Community Transitions
(CCT). CCT is California’s Money Follows the Person Program.
Numerous research studies cite access to affordable housing as a
barrier to transitioning a greater number of individuals out of
nursing homes; and

WHEREAS, Many state programs have sought to rebalance
spending of health care dollars toward home and community-based
services and away from institutional settings, such as nursing
homes. California is one of seven states that invested more
Medicaid long-term care funding for Home and Community-Based
Services than for long-term institutional care based on data from
the 2008 and 2009. Subsidized housing communities can support
additional rebalancing efforts by offering economies of scale that
can increase service delivery efficiencies. These efficiencies can
result in a more regular support presence and more affordable care;
now, therefore, be it

Resolved by the Senate and the Assembly of the State of
California, jointly, That the Legislature applauds methods that
promote greater collaboration between affordable housing providers
and HCBS that divert seniors from institutionalization and
encourage aging in place; and be it further

Resolved, That the Legislature urges the President and Congress
of the United States to support housing with services models to
achieve federal goals of using subsidized housing as a platform
for service delivery; and be it further

Resolved, That the Legislature encourages the President and
Congress of the United States to expand Sections 1115 and 1915(c)
federal Medicare waivers to test and integrate services into
affordable housing settings; and be it further

Resolved, That the Secretary of the Senate transmit copies of
this resolution to the President and the Vice President of the United
States, to the Speaker of the House of Representatives, to the
Majority Leader of the Senate, and to each Senator and
Representative from California in the Congress of the United
States.