Hi, I'm Juliana Bilowich, with LeadingAge. LeadingAge is a national non-profit organization dedicated to an America freed from ageism. We represent providers across the whole continuum of aging services, including senior housing communities. As the Director of Housing Operations and Policy for LeadingAge, I'm here to talk to you today about how senior housing communities can navigate Covid-19 as safely as possible. Taking a look at our learning objectives, we'll start by identifying the impact of Covid-19 on senior housing settings. Then we'll review the unique challenges for housing providers responding to a health crisis. Lastly, we'll develop an awareness of pandemic preparedness options for senior housing. Starting here with the basics of who and what we're talking about. While there are many different kinds of senior housing across the country, I'll be focusing a lot on a subset of senior housing that has faced some very unique challenges during this pandemic. We'll go over those challenges together. The numbers you see on this slide refer to older adults served by federal housing assistance programs in a multi-family or congregate setting. This is affordable, independent living that is subsidized by the federal government in one way or another, and sometimes also paired with services to support older adults as they age in community. By the numbers, we're talking about 1.8 million affordable housing apartments through HUD, that's the Department of Housing and Urban Development, that are headed by someone who's 62 or older. 1.8 million modest senior apartments across the country. We're also talking about just over 800,000 senior apartments that are financed through the low-income housing tax credit program, which is the federal government's main tool for financing the construction of new affordable units. Lastly, the country has over a 120,000 senior apartments subsidized through the USDA, that's the Department of Agriculture, through their rural housing service. Each of these programs leverage partnerships with landlords and property owners to make housing affordable based on a person's income. They differ slightly in terms of eligibility to participate and the kinds of housing that's available. But the main takeaway for you here, is that these programs provide housing assistance to a lot of older adults in both rural and urban areas. But who actually lives in these apartments? We can use this slide to get a picture of the older adults we're talking about. HUD's Section 202, supportive housing for the elderly, is HUD's flagship senior housing program. Apartments in this program are funded through different kinds of subsidy to bridge the gap between what is affordable for a tenant or resident to pay, and what the unit costs as determined by the areas housing market. Again, this is independent housing owned and operated by a private, and in the case of this program, non-profit housing provider, that receives government subsidy so that older adults with low, very low, or extremely low incomes can afford to live there. Looking at the demographics of this program, the average annual income for the entire household in each apartment in HUD's Section 202 is just over $13,500 per year. If you divide that by 12, that's 1,100 per month or so. And that needs to cover housing costs, food, prescriptions, other medication, all regular expenses that a person has. Some more demographics here. 38 percent of these residents are frail or near frail. Even though the eligibility for these apartments start at age 62, a good chunk of them are headed by someone who is 85 or older. One last statistic I want to share with you, you can see from these demographics that this population needs not just a roof and four walls, but supportive services as well in order to aging community. That could include assistance connecting to meals, through meals-on-wheels for example. Or assistance filling out forms for health care, or getting access to homemaking or other in-home support services, or help getting transportation to the grocery store. Many of the older adults residents with low incomes are lacking support systems. Meaning, that they also benefit from activities programs and wellness checks on both the physical and mental health side of things. But in fact only half of Section 202 communities have what's called a service coordinator. Someone whose job it is, to coordinate services and support for the residents. We'll talk more about service coordination and resident well-being later on in this course but for now I'll just say that at leading age, we're constantly working to get more service coordination into these communities and overall are more of an emphasis on service enriched housing. Not just an affordable housing but all types of communities where older adults live. Because we see this as critical for improved quality of life to age with dignity regardless of income. Before we move on, let's take a moment to consider who we're leaving out when we talk about Federal Housing Programs. In fact, only just over one-third of older adults who income qualify that is, paying market rate for housing is unaffordable to them. Only 36 percent actually receive those housing assistance benefits. To put that into real numbers for you, that's roughly 1.4 million out of four million households, who then actually receive the federal housing assistance they qualify for. This affordable housing shortage puts those underserved populations at high risk of housing instability and of course also, heightened health risks especially during this current health and economic crisis. This affordable housing shortage puts those underserved populations at high risk of housing instability and of course also heightened health risks, especially during the COVID-19 pandemic. Switching back to the older adults, who are served by federal housing assistance. Now that we know more about the senior housing communities and the people who live there, let's put this into the COVID-19 pandemic context. The first thing you'll note on this slide is of course, a critical risk factor for COVID-19 and that's age. Some other risk factors for COVID-19 include obesity and other existing medical conditions like diabetes and lung disease or in general, a weakened immune system. These make up some of the groups of people who are more likely to have severe disease if they do get infected. Comparing what we just heard about COVID-19 with what we know about residents of HUD-Assisted senior housing, we know that these residents are already at risk because of their age. By the way, the average age for Section 202 through HUD is 79 years. HUD- Assisted residents are also more likely to have underlying health conditions than their peers who don't receive housing assistance, so another risk factor there. Then based on income they have fewer resources to prepare or respond to a crisis. Lastly, they're more likely to experience interruptions in their access to services. For example, if they rely on a senior center or community organized meal program that had to temporarily shut down or curb services because of the pandemic. One other major risk factor I want to mention here, is racial and ethnic minority group health. Of course there are many factors impacting racial and ethnic group health and that includes things like discrimination, health care access and utilization rates. Also, key things like housing access and other structural gaps in our society. Through this pandemic, we've seen just staggering COVID-19 data related to ethnic and racial minority health disparities. To take a look at these numbers from the CDC related to deaths for population. Starting with Black or African-American persons at 92.3 deaths per 100,000 and decreasing from there over Hispanic white all the way down to Asian persons at a significantly lower 34.5 deaths per 100,000. Just a profound disparity here in these numbers. This is important to think about for senior housing providers because racial and ethnic minorities are in fact overrepresented in HUD housing. Now let's take all of this information and pair it with what we know about the senior housing community setting. Even though these settings serve a very similar population in terms of age, and services, needs of the residents as nursing homes and assisted living communities, the senior housing communities are not medical facilities. Meaning they've gotten very little direct guidance about how to navigate the crisis. Remember, only about half of them have some kind of service coordinator assisting residents with access to support services. In fact, these communities have very little staff in general, maybe a property manager, and a maintenance and cleaning personnel in a building with often 100-plus residents. There's also a very tight budget that's pre-approved by HUD down to the line item. Meaning there are few options to increase cash flow or access other financial options in the event of a crisis. These are also porous buildings with usually many entrances that are not necessarily monitored. The residents in independent living can't be restricted in terms of their own movement. These two factors make it a very difficult scenario to control in an infectious disease situation. One last thing I want to mention here, and that's that very few senior housing communities have access to the internet for the whole community, including residents. In a situation where technology and internet access have taken on such importance for information sharing but also for social connectivity and telehealth access, this has put these communities at a huge disadvantage. All in all, you can see the various factors that put the residents in these communities in a high-risk bracket. It's also why senior housing providers across the country have been working around the clock and with relatively little support to keep these communities as safe as possible. Let's wrap up this section by taking a look at how senior housing communities have fared so far through the pandemic. The numbers you see on this slide show two things; the prevalence of COVID-19 cases in senior housing communities and the financial strain that the pandemic has put on the housing providers to continue operating and providing housing or service enriched housing. This is from a national survey of our affordable senior housing membership, and as you can see, more than 59 percent of housing providers who responded are aware of COVID-19 cases at the community. Again, because housing providers are not medical personnel, they're not always aware of confirmed cases, so this number could actually be even higher. Lastly, here are the financial impacts. I mentioned before the tight budgets that these communities operate under. Yet this has been a very expensive crisis for providers to respond to, both in terms of revenue loss with a decrease in rent receipts, and in terms of expenses because of the immense and unbudgeted costs that housing communities have incurred from thousands of dollars per PPE. This for a type of community that likely didn't previously even have PPE in their budgets, to plexiglass barriers, to extra services and supports for the older adults who are suffering from social isolation and disruption in services, to constant cleaning and disinfecting, to new technology to facilitate remote staff and resident interactions. With money from what's called the CARES Act approved by Congress in March of 2020, HUD has made some reimbursement options available through what are called CSPs, COVID-19 supplemental payments. Those were first issued in September of 2020, and there's a new round of those coming available in later in 2020. However, from accounts from housing providers, we know that the costs of the crisis outpaced what was available for reimbursements. In review, we've learned about the kinds of communities and residents that make up the senior housing we'll be focusing on for this course and we've discussed some of the unique challenges that senior housing providers face during the COVID-19 health crisis.
