Elder homelessness has existed “under the radar” of many homelessness programs and funding sources. It is a complex problem with distinct challenges for which “traditional” approaches to ending homelessness such as job training and asset development are not applicable. Managing medications, maintaining a healthy diet, having regular access to physical and mental care, and developing social networks are just some of the elements of aging that are difficult for elders to manage when they don’t have a home. Think about all the things we do for our aging parents or grandparents, and imagine the people who are walking Boston’s streets, whom you might bump into, who (through no fault of their own) are not privileged enough to have safe homes or loving families. Here at Hearth, we work hard to ensure that homelessness is not the only outcome for elders with limited resources and personal difficulties. Hearth began as in 1991 as the committee to end elder homelessness. We run our own housing and supported services (7 sites, 136 units), but the main way to end elder homelessness is through outreach.
I hope you all got our report today on the importance of service-enriched housing to end elder homelessness. We were grateful to work with our longtime BU Partners on this, Sally Bachman and Judith Gonyea. 81% of our residents participated in this report survey and of those, 40% were previously chronically homeless. Our units are all subsidized. The Hearth team is made up of masters trained licensed social workers, registered nurses, personal care homemakers, site directors and overnight managers. We believe that the on site team is critically important because they work closely together and are very aware of changes in residents. They can see when someone is not paying bills and needs the rep payee program, isn’t caring for a wound, isn’t eating properly or interacting with others as much as they used to. Our team is prepared to recognize issues and deal with the fact that most will become increasingly dependent as they age. Annie Story : I want to tell you about Annie who at 65 years old was suffering from Diabetes, coronary artery disease, congestive heart disease, seizures, chronic back pain and anxiety to name a few. One year prior to moving into Hearth’s Ruggles Assisted Living she had been to the Boston Medical Center ER 34 times and had 15 hospitalizations with short term rehab stays – imagine the cost of that. Since moving to Hearth and working with our team – the nurse and the social worker who communicated regularly with the BU Geriatric Team, Annie became safely housed and in the next year was seen in the ER 5 times and hospitalized 4 times, her serious diseases and anxiety were managed well AND she was able to happily function in the Ruggles community. We have many stories of our team making some of the most challenging situations – people who had been on the streets for decades – work.
Tiers: The bottom, middle and top income tiers each represent one-third of the population age 65 and older. The bottom tier includes those with annual income of $16,758 or less. Seniors with income between $16,758 and $37,161 fall into the middle tier. The top tier encompasses income above $37,161. Pensions: Railroad retirement, government employee pensions (includes federal, state, local and military pensions) and private pensions (DB) or annuities Assets: Income from assets Other: Public assistance and other
As you can see from this chart Hearth is able to provide our service enriched housing and assisted living housing for relatively reasonable sums of money. We know it is cheaper than leaving Annie, and many other sick elders, in shelter. In many cases, even at our supportive housing, we are able to provide enough support to keep people from ever having to enter an expensive nursing home. Our housing retention rate is 97% - most leave when they pass on. And our model is a good deal cheaper than seeing people go from shelter into the hospital and then into a nursing home because there is no other place for them. People need support when they age and we need to be able to provide that.
Senior Housing presentation
Title Senior and Supportive Housing Metropolitan Area Planning Council Annual Meeting June 1, 2011 Newton, MA Mark Hinderlie, President & CEO Hearth, Inc.
About Hearth Founded in 1991, Hearth continues to be the only organization in the country with a sole focus and comprehensive approach to ending elder homelessness. Hearth partners with many organizations serving the homeless on a targeted approach for older adults age 50 and over. Hearth Housing & Services 8 sites, 196 units Hearth Outreach 1,000 elders placed 3,000 served (capacity to help 250 elders annually) <ul><li>Assorted Social Service Agency Partners </li></ul>COMMUNITY COLLABORATORS <ul><li>Homeless Shelters </li></ul>
About Supportive Housing… Supportive housing is a successful, cost-effective combination of affordable housing with services that helps people live more stable, productive lives. Supportive housing works well for people who face the most complex challenges—individuals and families who are not only homeless, but who also have very low incomes and serious, persistent issues that may include, chronic health conditions, disabilities, substance use, mental illness, and HIV/AIDS.
<ul><li>Subsidized Units </li></ul><ul><li>Multidisciplinary Support Team </li></ul><ul><li>Health Assessments and Treatment Planning </li></ul><ul><li>Care Coordination </li></ul><ul><li>Medication Management </li></ul><ul><li>Crisis Management </li></ul><ul><li>Representative Payee </li></ul>Hearth’s Supportive Housing…
Massachusetts's Aging Population Source: U.S Census Bureau, Population Division, Interim State Population Project, 2005; UMass Gerontology Jan Mutschler Over the next 20 years, Massachusetts population growth will occur almost entirely in the 60+ age groups Change in population 2010 - 2030
Poverty and the Lack of Affordable Housing Two critical issues Source: US Census, American Community Survey, and the Employment Benefit Research Institute & Lifelines for Elders Living on the Edge <ul><ul><li>Today, 3.6 million American seniors live below the federal poverty line and millions more are just making ends meet. In Boston, 1 in every 5 elders lives below the poverty line. </li></ul></ul><ul><ul><li>Annual cost of living for an elder individual renting a one bedroom apartment in Massachusetts was $24,496 in 2008. </li></ul></ul>FROM US CENSUS ANNUAL MEDIAN HOUSING COSTS ANNUAL MEDIAN INCOME FOR ELDERS 65+ DIFFERENCE US $11,000 $19,000 +$8,000 Boston $16,000 $13,000 -$3,000
<ul><li>Americans 65 and older rely heavily on Social Security for their retirement income — even at the top income bracket </li></ul>Sources of Retirement Income Source: Calculations by the Center for Retirement Research at Boston College, based on the U.S. Census Bureau 2009 Current Population Survey; Credit: Alyson Hurt / NPR
2009 Elder Standard for Single Elder in Suffolk County vs. MA SSI Payments & Federal Poverty Levels
Boston Area Elder Living Costs & Long-Term Care Costs 2009 Source: MetLife Survey of Long-Term Care Costs 2009, UMass Boston Gerontology Institute, Massachusetts Elder Economic Security Standard Index 2009
Developing Hearth Housing An Example Funding Sources <ul><li>Tax Credit Equity : this is private equity thru an investor’s use of credits that come from Feds to the state </li></ul><ul><li>Public Equity : Federal Home Loan Bank of Boston – Affordable Housing Program </li></ul><ul><li>Philanthropic Support </li></ul><ul><li>Other: </li></ul><ul><li>Eastern permanent mortgage </li></ul><ul><li>DHCD HOME grant </li></ul><ul><li>Facilities Consolidation Fund (DMH) </li></ul><ul><li>MassHousing Affordable Housing Trust Fund </li></ul><ul><li>DND HOME </li></ul><ul><li>DND Neighborhood Housing Trust </li></ul>Olmstead Green Development 59 units of affordable housing for formerly homeless older adults
Public policy challenges… <ul><li>We don’t have nearly enough affordable housing, but </li></ul><ul><li>Affordable housing development is incredibly complex and difficult, and </li></ul><ul><li>Supportive housing requires services, but service funding streams are narrow, access is uncoordinated, and don’t consider the critical role of housing </li></ul>
Hearth’s Sources of Revenue <ul><li>Nearly half of Hearth’s revenue comes from rental fees and program revenues. </li></ul>
Outcomes for Hearth Residents <ul><li>Housing with integrated supportive services leads to good outcomes for elders who have struggled with the consequences of poverty and homelessness. </li></ul><ul><li>95% of Hearth’s survey respondents report a visit with a primary medical care provider within the previous six months, demonstrating Hearth’s success in forging connections between its elder residents and critically important community-based care. </li></ul><ul><li>Access to safe, affordable housing and a supportive living environment promotes stability, wellness, and life satisfaction among formerly homeless older adults. </li></ul>
Outcomes for Hearth Residents continued <ul><li>Many of those participating in a recent Hearth survey reported positive assessments of their health and well-being as residents of Hearth’s housing, despite the numerous and serious health challenges they experience: </li></ul><ul><ul><li>68% of respondents rate their health (including physical, emotional, and mental health) as either good, very good, or excellent. </li></ul></ul><ul><ul><li>70% of respondents report being either satisfied or very satisfied with their lives, in general </li></ul></ul><ul><ul><li>78% of respondents express satisfaction with their living environments, with an additional 10% expressing neither satisfaction nor dissatisfaction. </li></ul></ul>
<ul><li>The cost of Hearth housing is at most one-half the cost of institutional alternatives such as long term care or shelter beds. </li></ul><ul><li>There are high costs associated with leaving elders in shelter or on the street which include costs such as increased use of emergency medical care for routine care. </li></ul><ul><li>At over $51,000 a year on average in Massachusetts for assisted living and $107,000 for nursing home care, assisted living is generally unavailable to most poor and minority elders. At Ruggles, Hearth is able to provide access to this high level of care for Boston’s very low income, frail elders who otherwise would be living in nursing homes on Medicaid’s tab. </li></ul>Hearth’s Strategy Makes Sense
Recognition of Hearth’s Model <ul><li>Hearth has received 15 different local and national awards recognizing its community leadership, high-quality innovative programs, fiscal responsibility, and achievements in increasing the supply of affordable housing for vulnerable populations. </li></ul><ul><li>Hearth’ Outreach Program was recognized as a 2009 Social Innovator by the Social Innovation Forum of Cambridge, Massachusetts. </li></ul><ul><li>Hearth’s Anna Bissonnette House was recognized as a Best Practice by the Los Angeles Shelter Partnership. </li></ul>