BILL NUMBER: SJR 11 CHAPTERED BILL TEXT RESOLUTION CHAPTER 84 FILED WITH SECRETARY OF STATE AUGUST 20, 2013 ADOPTED IN SENATE AUGUST 15, 2013 ADOPTED IN ASSEMBLY AUGUST 12, 2013 AMENDED IN ASSEMBLY AUGUST 5, 2013 INTRODUCED BY Senator DeSaulnier APRIL 29, 2013 Relative to housing with services. LEGISLATIVE COUNSEL'S DIGEST SJR 11, 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. 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 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) 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.