BILL NUMBER: SJR 11 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 5, 2013
INTRODUCED BY Senator DeSaulnier
APRIL 29, 2013
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
direct the Centers for Medicare and Medicaid Services 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
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
WHEREAS, Services are provided by appropriately credentialed
providers and can include care coordination from an interdisciplinary
team, resident service coordinators, and health educators; and
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
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
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
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
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
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
WHEREAS, In 2006, HUD reported that 38 percent of all Section 202
properties had a service coordinator on staff; and
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
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
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
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
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
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
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
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
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
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
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
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 home and community-based services
that divert or delay 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 ,
innovations, and funding 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 direct the Centers for Medicare
and Medicaid to expand Sections 1115 and 1915(c)
federal Medicare Medicaid 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, the appropriate policy committees
of both the House of Representatives and the Senate of the United
States, and to each Senator and Representative from California
in the Congress of the United States.