October 30, 2001
FEDERAL ELDERLY CONGREGATE HOUSING SERVICES AND ASSISTED LIVING
By: Helga Niesz, Principal Analyst
You asked (1) for the number of elderly congregate housing facilities funded by the federal Department of Housing and Urban Development (HUD) located in Connecticut, (2) if any of them (or other HUD-funded elderly housing facilities) offer assisted living, and (3) if HUD provides federal money for assisted living.
HUD does not officially designate “elderly congregate housing” limited to the frail elderly in need of such services the way the state does. But 12 federally assisted elderly housing complexes in Connecticut provide some type of “congregate services” to frail seniors under the federal Congregate Housing Services Program (CHSP). Two of these are HUD-funded (Mansfield Retirement Community/Juniper Hill Village in Storrs and Horace Bushnell Congregate Homes in Hartford); the others are funded by the U.S. Department of Agriculture's Rural Housing Services (RHS). The program, under which both HUD and RHS issued grants for these services, continues to fund existing grants, but has not issued new grants since 1995.
Full assisted living services in HUD-funded elderly housing are available at only three facilities, which are not part of the CHSP program. These are Tower 1/Tower East in New Haven, Immanuel House in Hartford, and Federation Homes in Bloomfield. At the first two facilities, a state demonstration program funds assisted living services. At Federation Homes, residents who need the services must pay for them.
Last year, HUD began providing federal competitive grants for capital expenditures to convert elderly housing to assisted living. HUD does not provide money to pay for the actual services, but the state demonstration program does pay for all or part of the services for those who qualify. People who qualify for HUD Section 8 rental assistance can now use their housing vouchers to cover part of the shelter costs (but not services) at a facility that offers assisted living. Medicaid money, which consists of 50% state and 50% federal funds, can also be used to pay for assisted living services, but a state must receive federal approval to use it for this purpose.
FEDERAL ELDERLY HOUSING AND CONGREGATE HOUSING SERVICES PROGRAM
HUD does not differentiate between regular elderly housing and elderly congregate housing the way the state does. (Connecticut has 24 state-assisted, elderly congregate housing facilities. They are listed in enclosed OLR Report 99-R-0270. State-assisted congregate housing is intended exclusively for frail people over 62 years of age who can still live independently but need some assistance. It usually consists of independent apartments; some common spaces; at least one meal a day; and some assistance with housekeeping, transportation, and other services.)
HUD-assisted elderly housing can be in regular public housing or in the Section 202 Supportive Housing for the Elderly Program, which provides capital grants to build housing specifically for low-income people over age 62 but is not limited to those who need assistance with activities of daily living. Section 202 facilities typically have private studio or one-bedroom apartments with kitchens and baths. They also have some special features such as grab bars, no-skid flooring, and ramps. Some now have resident services coordinators who connect residents to services available in the community. They may also provide access to some supportive services such as home-delivered meals and transportation to medical appointments, but they are basically still independent living.
The federal government uses the term “congregate services” to refer to the enhanced services provided under CHSP. CHSP's biggest component is the meals program where qualified tenants pay a minimal amount for one or more meals on a sliding scale based on their income. Other CHSP services can be a resident services coordinator, personal assistance, housekeeping, transportation, and other services. Eligibility for the services is limited to frail elderly (seniors who are deficient in three or more activities of daily living) and non-elderly people with disabilities. The program appears to have helped residents “age in place,” avoiding the more costly shift to nursing homes. Most of these properties also have resident service coordinators to further oversee the tenants' care.
CHSP gave grants to a number of federally assisted elderly housing complexes in Connecticut. No new grants have been available since 1995, but the program continues to fund services to existing grantees. Only two of these grantees in Connecticut are HUD-assisted housing: Mansfield Retirement Community/Juniper Hill Village in Storrs and Horace Bushnell Congregate Homes in Hartford (both Section 202 housing).
The other 10 CHSP grantees receive their money not from HUD, but rather from Rural Housing Services (formerly Farmers' Home Administration), which also assisted in their construction. The grants are administered through the State Department of Social Services, which subcontracts with the Area Agencies on Aging. These grantees are:
Cedar View Village in Plainfield
Eastwind Village in Plainfield
GA-NA-DEN1 in Willimantic
GA-NA-DEN2 in Willimantic
Grace Meadows in Southbury
Little River Acres in Putnam
Moosup Manor in Moosup
Nunnawauk Meadows in Newtown
Spruce Bank Farms in Woodbury
Westfield Village in Danielson (also receives HUD Section 8 funding for rental assistance)
“Assisted living” is a relatively new model of care that provides a higher level of assistance to elderly people who may not need or want nursing home care, yet need some help with activities of daily living like eating, bathing, errands, and chores. In Connecticut, an assisted living services agency (ALSA) provides the “hands on” services in managed residential communities (MRCs). The ALSA must have a nursing supervisor on-site at the MRC for specified hours. The resident has his own apartment but shares some services with other tenants, such as meals in a common dining room, laundry services, social activities, and transportation, which the MRC must provide. Assisted living provides more assistance than those in ordinary state-assisted congregate housing receive. Until recently, these services were mostly available only in upscale elderly housing developments and there was no government help in paying for the services in Connecticut.
Only three HUD-funded elderly housing facilities that we know of currently offer full assisted living services: Tower One/Tower East in New Haven, Immanuel House in Hartford, and Federation Homes in Bloomfield. While residents of Federation Homes must pay for the assisted living services themselves, Tower One/Tower East and Immanuel House in Hartford are part of a state demonstration program started in 2000 that allowed state funding for assisted living services in two federally funded elderly housing projects. In 2001, the legislature doubled that to potentially four such projects, but the other two have not yet been chosen.
The demonstration program pays for all or part of the cost of these services for people depending on their income, with copay requirements at higher income levels. The Connecticut Home Care Program (CHCP) pays for those who qualify and meet its financial requirements, with copays for some participants at higher income levels. Separate Department of Economic and Community Development funding pays part of the cost for those who do not qualify for CHCP.
(Seventeen of Connecticut's 24 state-assisted elderly congregate housing complexes are also now providing assisted living services, subsidized by CHCP. And the first of five other demonstration projects in state-assisted affordable housing is likely to be up and running in 2002. CHCP will also pay for some or all of the services for qualified residents in these new projects.)
HUD AND OTHER FEDERAL FUNDING FOR ASSISTED LIVING
HUD Section 202 Assisted Living Conversion Grants
This recent program gives grants to nonprofit owners of HUD-assisted elderly housing to convert some or all of their apartment units and common areas into assisted living facilities. These grants can only be used for capital expenditures. HUD money does not pay for services; those must be provided by the facilities' owners, either directly or through a third party. Tower One has received one of these conversion grants for over $4.2 million to modify about 30 apartments by next spring; the state demonstration program funding that pays for services will serve as the required matching funding for this federal grant.
HUD Section 8 Vouchers
In September 2000, HUD allowed public housing authorities to provide Section 8 rental assistance, in the form of housing choice vouchers, to people who live in assisted living facilities, as authorized in PL 106-74. Qualified tenants can use the vouchers to cover all or part of the assisted living unit shelter costs, but not the actual assisted living services.
Federal money for providing assisted living services can come through Medicaid, which is a joint state-federal program. For instance, Connecticut's program for providing assisted living in state-assisted elderly congregate housing facilities and its planned 300-unit demonstration program in five affordable housing locations use both Medicaid waiver home care money (which consists of state expenditures that are 50% reimbursed by the federal government) and purely state money to pay for the services.
It is also possible for states to ask the federal government for approval to amend their Medicaid state plan to pay for assisted living services, which some states, but not Connecticut, have done.