Report Explores Affordable Assisted Living

By Kleyman, Paul | Aging Today, November/December 2003 | Go to article overview
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Report Explores Affordable Assisted Living


Kleyman, Paul, Aging Today


Chang Shou Zhou was age 92 when he became the first tenant to move into the brand-new assisted living facility, Presentation Senior Community, in San Francisco's Tenderloin district on April 3, 2001. He lives in his own studio apartment, takes advantage of the Presentation Adult Day Health program five days a week, and says he enjoys the "good meals" that Project Open Hand delivers every weekday at noon.

Mary Frances Mangum moved into Presentation from San Francisco's Laguna Honda Hospital, the largest city-run nursing home in the United States. Despite suffering from cataracts, glaucoma, organic brain disease, vascular disease and dementia, Mangum, now age 77, was able to transfer. She continues to be an avid reader, especially of old mysteries and biographies. She relies on the help of the In-Home Supportive Services program, which provides an aide in the morning and another in the afternoon. Although at first she resisted attending Presentation Adult Day Health, she currently participates in the program two days per week.

These two elders are among 139 residents of the 92-unit publicly subsidized assisted living facility that a consortium of nonprofit organizations and advocacy groups for elders took 10 years to plan and have built. Across the country in Cambridge, Mass., low-income elders moved into 71 units at Neville Place in 2001, following a five-year effort by the Cambridge Housing Authority and the nonprofit Neville Community Partners, a consortium of housing and health groups. They joined to rehabilitate the historic building that houses the facility. Located in bustling West Cambridge, Neville Place includes expansive grounds, mature woodlands, community gardens and a public walking path that follows the perimeter of adjacent Fresh Pond. The senior-living campus will also soon include a skilled nursing facility.

Presentation and Neville Place are two of five model assisted living facilities described in Affordable Assisted Living: Surveying the Possibilities by Jenny Scheutz, which was issued earlier this year by Volunteers of American and the Joint Center for Housing Studies at Harvard University. The study examines why providing affordable assisted living is "such a Herculean task" throughout the United States. The report elaborates, "Even in the private-pay market, assisted living is inherently a complicated, expensive and high-risk product. The combination of housing and extensive personal care services is unavoidably costly and operationally demanding. The hybrid nature of the product requires that providers have expeitise in real estate development-management and healthcare-social service delivery."

The dilemma, according to Scheutz, is that on the one hand lenders and investors in the private housing field face high risk if they enter the assisted living market while, on the other, those attracted to the affordable market confront fragmented funding sources, confusing regulatory oversight and an unstable political climate for supporting service-heavy housing. She also noted that the "fragmentation of funding drives up the already high cost of assisted living by adding more layers of complexity to the development process and requiring ongoing monitoring from various funders. A wide range of government agencies become involved in a single project, exposing projects to potentially conflicting regulations without one agency having clear responsibility."

The report emphasizes that without an expansion of assisted living aimed at lower- and middle-income people, "virtually all seniors with [annual] incomes below $15,000 WILL be unable to afford private-pay assisted living." Furthermore, Scheutz estimates, many of those with incomes between $15,000 and $35,000 will be unable to move into private-pay units unless they either hold substantial assets they can liquidate or receive help from their families.

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