4.12 Serving the Aging and Medically Frail Homeless Population (Graf)


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Housing and serving elderly or medically frail homeless people means addressing their high health care and home care needs. It requires the design and use of service and housing models that are different from those used for most other homeless people. Providers of services to these populations present the most effective service and housing models and discuss the challenges they have overcome to end homelessness for this growing, high need population.

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4.12 Serving the Aging and Medically Frail Homeless Population (Graf)

  1. 1. Housing the Elderly HomelessThe Mercy Housing experience at Mission Creek Senior CommunityNAEH ConferenceJuly 13, 2010Jane Graf President, Mercy Housing Ca<br />LIVE IN HOPE<br />
  2. 2. Mission<br />To create stable, vibrant and healthy communities by developing, financing and operating affordable, program-enriched housing for families, seniors and people with special needs who lack the economic resources to access quality, safe housing opportunities.<br />Founded in 1981 by the Sisters of Mercy, Omaha<br />LIVE IN HOPE<br />
  3. 3. MajorActivities<br />Housing Development<br />participated in the development, preservation and/or financing of more than 37,200 affordable homes<br />serving more than 128,000 people<br />Property Management<br />Manages 16,132 apartment homes <br />236 Mercy Housing properties<br />37 properties managed for other non-profits<br />Staff in 17 states<br />Operate in 5 major markets nationwide<br />LIVE IN HOPE<br />
  4. 4. Mission Creek<br />139 one bedroom apartments for frail & formerly homeless elderly<br />Opened March, 2006<br />LIVE IN HOPE<br />
  5. 5. Funding & Partners<br />11,340,429 San Francisco Redevelopment Deferred loan<br />13,092,518 National Equity Fund – equity on 4% LIHTC<br /> 1,000,000 San Francisco Redevelopment – HOPWA<br /> 360,000 San Francisco Redevelopment – CDBG<br /> 451,069 SFRA-Hazardous Materials Loan<br /> 7,500,000 State MHP-Residential and nonresidential<br /> 8,017,513 Citibank-bonds<br /> 625,500 AHP with BofA<br /> 396,472 GP Equity & Early Occupancy income<br /> 100,000 Northern California Community Loan Fund Grant<br />$42,883,501 total sources<br />Cost: $42,883,501 <br />Per square foot: $246 <br />Per unit: $306,610<br />Total Bldg size: 166,295 square feet<br />Total Commercial: ADHC: 6,198 Square feet; retail: 3,936 square feet<br />Library: 7,449 square feet in a condo – not in dev cost<br />LIVE IN HOPE<br />
  6. 6. 88 units serve <50% AMI = $39,600/annual income max<br /><ul><li>$1,353/month/unit = contract rent
  7. 7. Project based Sec 8 rent subsidized; residents pay 30% of income – referred by the SF Housing Authority </li></ul>51 units serving formerly homeless<br /><ul><li> < 20% AMI= $15,840/annual income max
  8. 8. $969/month/unit</li></ul>DPH subsidy = $592/month; resident = $377/mo<br /><ul><li>Residents are formerly homeless referred through DPH </li></ul>Rents<br />LIVE IN HOPE<br />
  9. 9. Courtyard<br />LIVE IN HOPE<br />
  10. 10. Resident activities<br />Ti Chi <br />Group meetings<br />LIVE IN HOPE<br />
  11. 11. Resident activities<br />Halloween<br />LIVE IN HOPE<br />
  12. 12. Resident activities<br />4th of July Celebration<br />LIVE IN HOPE<br />
  13. 13. Unit Plan<br />LIVE IN HOPE<br />
  14. 14. Typical Unit<br />LIVE IN HOPE<br />
  15. 15. Mission Creek retail<br />Philz Coffee Shop<br />LIVE IN HOPE<br />
  16. 16. Mission Creek Public Library Branch<br /><ul><li>The San Francisco Library has a branch on-site which serves the community and is widely used by the residents
  17. 17. Mercy Housing developed the space for the library which owns it as a condo </li></ul>LIVE IN HOPE<br />
  18. 18. Service Staffing<br />3FTE service staff as part of property management staff<br /><ul><li>2FTE Service staff; 1FTE Activities staff</li></ul>Full service Adult Day Health Center on site provided by Stepping Stones – medicaid eligible – 35 – 40 residents attend ADHC from Mission Creek Community<br />In Home Support Services as needed – medicaid eligible – 50% of units receive IHSS support<br />Case management provided by numerous agencies <br />Meals on Wheels meals as needed<br />51 DPH units set aside for formerly homeless<br />LIVE IN HOPE<br />
  19. 19. Services & Funding<br />Basic Services provided Funding Source <br />Dedicated services staff Rents and HUD subsidies<br />Adult Day Health Services Medicaid, Dept Public Health, & private pay (sliding scale)<br />In Home Support Services Medicaid<br />Case management Medicaid, Dept. Public Health<br />Meals Medicaid, County, private<br />Health services/visiting nurse<br />or Dr. hours SF Dept. of Public Health<br />Wellness promotion Self funded or City contract Substance Abuse support through other nonprofit <br />Money Management organizations<br />LIVE IN HOPE<br />
  20. 20. Findings from DPH Study<br />Of the 51 DPH homeless residents after 3 years:<br />78% still housed – 3 evictions; 3 to higher level care; 5 deaths<br />Average reduction of $29,000 per person/per year in Medical/Medicare reimbursed services<br />LIVE IN HOPE<br />
  21. 21. Reflections: public agency point of view<br /><ul><li>Advocacy efforts pushed the City of SF to start funding housing and services for homeless elders in 2005
  22. 22. SF policy is that all housing supported by City funds will have a 20% set aside for the homeless
  23. 23. Support is through City/County General Funds
  24. 24. $400 to $700 per unit/per month rent subsidy
  25. 25. $400/per resident service funding
  26. 26. City manages wait list for homeless residents and assures services
  27. 27. City loan committee that manages all City funding of affordable housing includes representation from:
  28. 28. Redevelopment Agency
  29. 29. Mayors Office of Housing
  30. 30. Department of Public Health
  31. 31. Department of Human Services</li></ul>LIVE IN HOPE<br />
  32. 32. Reflections: public agency (cont.)<br /><ul><li>Age criteria lowered to 55 to account for the advanced aging of homeless individuals
  33. 33. Direct Observation Therapy – aka medication management – is an essential component to success
  34. 34. Nursing hours are essential – for every 75 to 100 units of housing – not less than ½ day of nurse availability 2 to 3 times per week
  35. 35. All homeless residents in the program have access to a city owned health clinic (FQHC) that provides psychiatric and primary care
  36. 36. Rigorous conferencing on the needs of residents with medical personnel & the housing provider is essential to success</li></ul>LIVE IN HOPE<br />
  37. 37. Reflections from a houser<br />When the formerly homeless residents entered Mission Creek, highly skilled service staff needed to be available 7 days per week 12 hours per day<br />Constant attention needed to make the transition from the street<br />Needed help learning to cook/use appliances/basic things<br />Sounds indoors were foreign and caused alarm and fear<br />After 4 years, many formerly homeless residents remain isolated by choice – pro-active outreach is essential<br />Formerly homeless residents require a high level of patience from staff – continued meeting to deal with their concerns and willingness to go the extra mile to maintain them in housing<br />Site staff must have more than property management skills – they must have a commitment to services & the flexibility required to assure residents maintain their housing <br />LIVE IN HOPE<br />
  38. 38. Some lessons learned<br /><ul><li>Don’t assume people will take the services offered
  39. 39. Money management to assure payment of rent is vital to maintaining the seniors in their housing
  40. 40. Property management team experience and education is pivotal to success
  41. 41. People seem to work harder to maintain their housing based on the beauty of their environment
  42. 42. Partners with like minded vision is essential</li></ul>LIVE IN HOPE<br />