Amended in Assembly August 5, 2013

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 amended, 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 begin insert direct the Centers for Medicare and Medicaid Services to end insert expand Sections 1115 and 1915(c) federal Medicare waivers to test and integrate services into affordable housing settings.

Fiscal committee: no.

begin delete

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

end delete begin insert

WHEREAS, “Housing with services” describes subsidized,
residential properties occupied by low-income seniors that provide
access to a range of health and supportive services on a voluntary
basis; and

end insert begin insert

WHEREAS, Services are provided by appropriately credentialed
providers and can include care coordination from an
interdisciplinary team, resident service coordinators, and health
educators; and

end insert begin insert

WHEREAS, Housing with services may be colocated with a
federally qualified health center or Program of All-Inclusive Care
for the Elderly (PACE) onsite; and

end insert begin insert

WHEREAS, 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

end insert begin insert

WHEREAS, California is home to the largest number of seniors
in the nation, and this population is expanding at a pace that is
unprecedented in history; and

end insert begin insert

WHEREAS, The Department of Finance’s Demographic
Research Unit estimates that California’s population that is 65
years of age or older will grow by 43 percent, from 4.4 million in
2010 to 6.35 million by 2020; an additional 39 percent, to 8.83
million by 2030; and an additional 21 percent, to 10.5 million by
2040. Today roughly one in ten people are 65 years of age or
older. By 2035 roughly one in five people will be that age; and

end insert begin insert

WHEREAS, According to the American Community Survey,
while 10 percent of Californians over 65 years of age live in
poverty, and 21 percent live below 150 percent of the poverty line,
the percent of older Americans in poverty increases with age, with
the oldest of elderly people at the greatest risk of being poor; and

end insert begin insert

WHEREAS, Approximately 1.3 million very low income seniors
are assisted through publicly subsidized housing. 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, supporting approximately 263,000 units, of which
34,322 units are administered through HUD’s San Francisco and
Los Angeles hubs; and

end insert begin insert

WHEREAS, In 2006, HUD reported that 38 percent of all
Section 202 properties had a service coordinator on staff; and

end insert begin insert

WHEREAS, Service coordinators in HUD developments work
with residents to coordinate a wide range of services, including
transportation, meal services, housekeeping, medication
management, visits from nurses, dentists, and massage therapists,
haircuts, and social activities; and

end insert begin insert

WHEREAS, 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 activities
of daily living, such as eating, bathing, grooming, dressing, or
home management activities, and thus can be considered at risk
for premature institutionalization; and

end insert begin insert

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; and

end insert begin insert

WHEREAS, A satisfaction study found that residents residing
in HUD properties that offered service coordination were able to
avoid the higher costs of institutionalization by an average of six
months longer then residents who lived in properties that did not
offer service coordination; and

end insert begin insert

WHEREAS, In 2012, the cost of a stay in a nursing home funded
by Medi-Cal was approximately $82,500 annually on average,
while the cost of Section 202 housing with services, such as food,
transportation, and housekeeping, is estimated to cost
approximately $13,000 to $25,000, far less than the cost of skilled
nursing care; and

end insert begin insert

WHEREAS, As stated in HUD’s fiscal year 2013 proposed
budget, it is HUD’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; and

end insert begin insert

WHEREAS, HUD seeks to build formal and informal relationships
with public and private health care providers, and with health
education organizations, to provide access to health care
information and services for recipients of HUD assistance; and

end insert begin insert

WHEREAS, 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 includes $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

end insert begin insert

WHEREAS, The state is directed under the Olmstead Plan to
improve its long-term care system so that its residents are availed
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 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

end insert begin insert

WHEREAS, Many state programs have sought to rebalance
spending of health care dollars toward home and community-based
services and away from institutional settings; and

end insert begin insert

WHEREAS, 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. Subsidized housing
communities can support additional rebalancing efforts by offering
economies of scale that can increase service delivery efficiencies;
now, therefore, be it

end insert

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 begin delete HCBS end delete begin insert home and community-based services end insert that divert begin insert or
delay end insert 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 begin insert ,
innovations, and funding end insert 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 begin insert direct the Centers for Medicare
and Medicaid end insert begin insert to end insert expand Sections 1115 and 1915(c) begin delete federal
Medicare end delete begin insert Medicaid end insert 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, begin insert the appropriate policy committees
of both the House of Representatives and the Senate of the United
States, end insert and to each Senator and Representative from California in
the Congress of the United States.