Partners (Summer 2002)

Aging In Place:
Solutions to a Crisis in Care

The following is an excerpt from a paper prepared by the Southern District Office of Neighborhood Reinvestment Corporation through close collaboration between Colette Pozzo, Management Consultant, and Catherine A. Smith, Community-Based Communications, Cheverly, MD. In February 2002, NRC convened a forum to discuss the growth of the elderly population and its impact on the fields of housing, healthcare, and supportive services. This paper explores the challenges of facilitating ‘aging in place’ strategies, as well as presents solutions that are working within and outside of the NeighborWorks® network.

Aging in place refers to a well- established fact: the vast majority of seniors and those approaching retirement want to live out their years in their own homes. If for some reason they can’t stay in their homes, they at least want to remain in their immediate communities. This is especially true of low- to moderate-income seniors whose financial constraints limit their choices.

Ideally, seniors would be able to stay in their homes, have access to a progressive level of care as they become more infirm or frail, have the ability to afford and maintain their homes, and remain connected to (and not isolated from) others in the communities they know and love.

Among the things that get in the way of this for many elderly people are:

  • Incomes that don’t allow them to pay for the care they need or repair the homes they live in;
  • Wealth that is not liquid but instead is tied up in the equity of their homes;
  • A lack of affordable rental housing for those who are not homeowners; and
  • A system of providing healthcare, housing assistance, and other services that isn’t structured effectively or funded adequately to respond to the real needs faced by seniors.
Challenges to Seniors’ Maintaining Safe Housing, Good Health and Independence

Two anecdotes capture the intersection of affordable housing and health care that dominates the issue of helping seniors live where they want, stay in good health, and remain active in their communities.

  • In the Kirkwood neighborhood of Atlanta, Catherine Ivy of the Visiting Nurse Health System recalled a visit one day with Mrs. Jones (not her real name), an elderly woman she had known for about four months.

    After some trust was established between them, the woman said, "Ms. Ivy, I just want to show you something. I don’t think you can do anything about it, but I want to show you something." Mrs. Jones led the way into her bedroom, which Ivy had never been allowed into before. Overhead, in the ceiling, was a hole about two feet in diameter. You could see sky through it.

    Ivy asked, "Mrs. Jones, where are you sleeping?" She said, "In here. This is my bedroom." The hole wasn’t right over the bed, and Mrs. Jones explained she used a plastic sheet on rainy nights to keep from getting splattered.

  • Near Boston, Ellen Feingold of Jewish Community Housing for the Elderly told of Mrs. Greene (also not her real name), a tenant leader and real "go-getter" in one of JCHE’s buildings. In her late 80s, Mrs. Greene was on the tenant council, at the front desk, calling bingo — whatever activity was going on, she was there.

    Then one day, she stopped coming out of her apartment. People would call and ask, "Aren’t you coming to the tenant council?" and she’d say, "I don’t feel like it today."

    After about 10 days of this, Mrs. Greene’s friends urged Feingold and others to call. It turned out that Mrs. Greene could no longer put on her stockings, and since "no self-respecting lady would go out without them," she stayed in.

One woman had access to health services but a house that needed repairs; the other had a good home but needed help with daily life.

The stories of Mrs. Jones and Mrs. Greene both have happy endings: a local church fixed Mrs. Jones’s roof and made some other repairs and, for 50 cents a day, a neighbor came every morning to help Mrs. Greene put on her stockings.

But what if there weren’t a Catherine Ivy or an Ellen Feingold in their lives? Even if their pride didn’t stop them from seeking help, would they have known where to find it? And if they did find help, would the solutions have been as simplistic and affordable as these?

Like these two seniors, millions of others have problems getting adequate care or adequate housing, or both. They fall along a financial continuum from middle class to very poor or even homeless.

Among the serious obstacles in the way of providing needed care for seniors are:

  • A lack of safe, decent, and affordable housing;
  • The inability of seniors to find or pay for improvements or repairs;
  • No funding for long-term care and little for supportive services (except for the very poor, through Medicaid);
  • A lack of funding — or a dispersal of funding across numerous sources — that impedes innovation but also negatively affects even those programs that have been successful at providing elderly housing and/or healthcare;
  • Government agencies and other systems that are overloaded because of the increase in the elderly population and the decrease in funding, available staff, and other resources; and
  • Some federal and state regulatory and eligibility requirements that inhibit access to funding and to cooperative relationships among providers.

Nonprofit providers and government agencies are examining these obstacles and coming up with both some common sense and innovative ideas for overcoming them.

Creating Solutions

Neighborworks® organizations are already responding to the needs of these residents. The following are two examples:

Located in the suburban metro-Atlanta area, Gwinnett Housing Resource Partnership offers, as part of its counseling services, access to five reverse-mortgage products — two versions of the Home Equity Conversion Mortgage through HUD, a Fannie Mae product, and two products of Financial Freedom, a private lender.

GHRP provides counseling prior to accessing the products, which is required, though they do not make the loans. Their counseling services are funded through a HUD counseling grant to the organization and through AARP, which also has a HUD grant for this service.

The reverse mortgage products allow seniors to access the equity in their house without having to sell it and without having to make monthly payments. The borrower must be at least 62 years old to be eligible, and there must be enough equity in the property to pay off any existing liens or mortgages.

The percentage of the equity the homeowner receives is based on a variety of factors. The borrower can receive the money in a lump sum, in monthly advances, or as a credit line. There is no restriction on what the money is used for.

In response to the needs of elderly residents on fixed incomes, Neighborhood Housing Services of LaGrange, Georgia, developed a loan program in the fall of 2001 called 4/5/6: $4,000 for 5 years at 6%.

By June 2002, the organization had made repairs and modifications to 12 homes and has the funding in hand (through its revolving loan fund capitalized by Neighborhood Reinvestment) to work on any house in the city of LaGrange. For homes outside the city, NHS leverages its funds with CDBG and other sources to make it possible for local financial institutions to make affordable loans to seniors.

For some income-eligible residents, deferred second mortgages have made the difference in being able to access the resources needed to make repairs.
Housing Preservation

The idea that most seniors retire and move to Florida or Arizona is generally a myth, particularly with respect to the lower-income seniors served by NeighborWorks® organizations.

Seniors typically remain in their homes even as their housing needs change, some because they want to stay in their communities, others because their lack of wealth limits their choices. As a result, many seniors refuse to leave homes that are in fairly deplorable condition. Others whose homes are in good shape may still need modifications to help them cope with disabilities or avoid falls and other accidents that often precipitate their need for more serious health care.

Housing preservation is thus a critical piece of having seniors remain safe in their homes for as long as possible. It is also important to seeing that housing stock stays in good repair for the next generation of homeowners or for the family members who inherit. For the sake of the community, keeping these units in good repair and safe for the families who live in them helps to reduce insurance and health care costs and helps maintain property values.

However, reaching these seniors can be a challenge. Of the 5 million households that include a senior, 2 million express a need for modifications in order to function well. Seniors often don’t ask for such help, or they have trouble finding reputable contractors and affordable loans that make such renovations possible.

Ironically, many of the repairs that can greatly increase the longevity of both the housing and its occupants are relatively inexpensive: adding handrails near bathtubs, constructing wheelchair ramps, making minor improvements to roofs, repairing concrete steps, and other such modifications that can usually be done for less than $1,000.

Unfortunately, many contractors don’t want to do such small jobs, so either they inflate the work that needs to be done or a repair situation deteriorates until a small problem becomes a much larger and more costly problem.

Helping the Elderly Keep Their Homes

Through the efforts of the NeighborWorks® Campaign for HomeOwnership and the work of the organizations participating in the Campaign, it has become clear that financial literacy training and foreclosure prevention are important to preserving housing both for families and for the health of neighborhoods. Senior households are no exception.

Evidence of how serious a problem this has become appeared in an April 25, 2002, article in USA Today, which noted that, "although older Americans account for a small proportion of total personal bankruptcy filings, they are the fastest-growing group in bankruptcy. About 82,000 Americans 65 or older filed for bankruptcy in 2001, up 244% from 1991…"

Reasons for this sobering problem are many: a skyrocketing level of household debt — up 164% on average in eight years — much of it credit card debt; major medical emergencies (with out-of-pocket healthcare expenses for seniors having increased nearly 50% from 1999 to 2001); major home repairs; loans to children or grandchildren; and, sadly, exploitive relatives who get power of attorney and clean out the elderly person’s bank accounts. In some cases, loneliness and boredom result in seniors seeking solace in gambling, sometimes sending them spiraling into debt.

To meet these new financial burdens, more and more elderly Americans are taking out second mortgages on their homes. One downside of this is that, because many of their homes have appreciated in value, seniors are an easy and frequent target for predatory lenders. These lenders persuade seniors and others to take out high-interest loans that they can’t afford to repay. Some convince seniors to take out even more debt several times (known as flipping the loan), until they are so far in debt that they lose their homes.

Even if a senior can retain his or her home after being coerced by a predatory lender, this situation takes an emotional toll on the individual, furthering feelings of vulnerability and eroding self-confidence. The impact of such lending practices also affects the community as a whole, threatening to undo much of the neighborhood revitalization that has taken place over the past 20 years.

Informing the Larger Community

How to best meet the housing and health care needs of America’s seniors is becoming an increasingly discussed topic, from the dinner table to the halls of Congress.

The stresses on our delivery systems, from individual families caring for aging parents to the federally funded community programs, will only be exacerbated by the sheer number of people who become elderly in the coming years.

As can be expected, public debate has begun to focus on ways to better improve current programs as well as create new infrastructures that will help seniors age in place more successfully. Proposals cover a wide range of territory, from specific changes to HUD’s 202, HOME and Section 8 programs, to overhauls in Medicare and Medicaid. Regulations are being examined to assess ways that their enforcement might be impeding other efforts. Local governments are being asked to waive taxes and fees for elderly low-income homeowners.

The call for increased collaboration is also prevalent, between the Department of Health and Human Services and HUD, between the states and the federal government, and among service providers. And there is, of course, discussion of the need for more money, to build and preserve affordable housing, to provide services, and to cover health care and prescription drug costs.

NeighborWorks® network leaders have been instrumental in not only raising important issues but in sharing with one another the benefits of their actions on a variety of critical community concerns. The network is already positioned to readily and efficiently learn how to work with new funding sources and new industries to address the growing numbers and needs of seniors. NeighborWorks® organizations across the country will likely have a tremendous impact on this market and will do so with the sensitivity, foresight and creativity that has led to the network’s successes over the years.

The full text of this article is available by contacting Adrianne Hull with the Neighborhood Reinvestment Corporation at (404) 347-1016.

Map of United States

Source: 2000 U.S. Census

Where do the elderly live?
There are 34 million Americans above the age of 65. On average they make up 10 to 13 percent of each state’s population. Those states with the highest concentration of the elderly are Florida, the Northeastern region and the Midwestern corridor.


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