Bill Text: CA SJR11 | 2013-2014 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Housing with services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2013-08-20 - Chaptered by Secretary of State. Res. Chapter 84, Statutes of 2013. [SJR11 Detail]

Download: California-2013-SJR11-Introduced.html

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BILL NUMBER: SJR 11	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator DeSaulnier

                        APRIL 29, 2013

   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.