Report says nation not prepared to tackle senior housing crisis

Published in RINewsToday on March 11, 2024

With the graying of America, the nation is unprepared to provide needed housing and care for millions of seniors, warns a recently released 40-page report by the Cambridge-based Harvard Joint Center for Housing Studies.  The US population age 65 and over has skyrocketed 34% in the last decade, from 43 million in 2012 to 58 million in 2022. This growth is widespread, with urban, suburban, and rural communities across the country reporting increases in older residents, notes the report released on Nov. 30, 2023.

The report’s authors noted that over the same period, the share of households headed by older adults increased from 22 to 27% of all U.S. Households. The number of households headed by a person aged 80 and over will more than double between 2021 and 2040 to reach nearly 17 million households.  

Key takeaways of Harvard’s Housing Report

According to the report, “Housing America’s Older Adults 2023,” as the nation’s population of older adults swells, so, too, does demand for housing that is both affordable and able to accommodate older adults’ changing [health care] needs.   

Accessible housing is also in short supply, say the authors, noting that fewer than 4% of US homes offered the three key features of accessible housing—single-floor living, no-step entries, and wide hallways and doorways—at last measure.

As the US population ages, more older adults will struggle to afford either the home of their choice or the care they need, warns the report. “With subsidies for housing and LTC services scarce, many older adults will have to forgo needed care or rely on family and friends for assistance,” says Jennifer Molinsky, Project Director of the Housing on Aging Society Program at the Center. More funding would be a start, but there is tremendous need for creative alternatives to existing models of care and housing to better support the country’s rapidly aging population,” suggests the report. 

The report noted that seniors, whose incomes are often fixed or declining, increasingly face the “twin challenges” of finding affordable housing and the health care services they need to remain independent and at home. In 2021, an all-time high of nearly 11.2 million older adults were cost burdened, meaning they spent more than 30 percent of their income on housing. Cost burdens are particularly high for renters, homeowners with mortgages, and households aged 80 and over, the report emphasized.  

Costly long-term care (LTC) is out of reach for most seniors, the authors noting the cost of  LTC averaging over $100 per day, nationwide.  They say that most seniors who require these services, having very low incomes, have the fewest resources to pay for them. When LTC services are combined with housing costs, only 14% of single people 75 and over can afford a daily visit from a paid caregiver, and just 13% can afford to move to assisted living.    

The researchers say that government-funded rental assistance can provide crucial support to older adults with very low incomes, but demand dramatically outstrips supply. With homelessness on the rise among the older population, assistance is more important than ever, they add.  Even those with slightly higher incomes also struggle to qualify for government assistance; 29% of people living alone, aged 75+, have incomes above 50% of area median income, but cannot afford the cost of assisted living. Just 8% of this group could afford a daily visit from a home health aide, the report found.

Equity in housing as we age

The report also found that renters and homeowners of color face steeper burdens, too, in paying for housing.  While some older adults have home equity that can be tapped to pay for care or services, many do not. “This is not only because of the increasing number of older adults, but because of widening wealth and income inequality,” says Jennifer Molinsky, Project Director of the Housing an Aging Society Program at the Center, in a statement released on Nov. 30, 2023.  She served as the report’s lead author.

Older renters have only 2% of the net wealth of older homeowners and there are steep inequalities among owners as well; older Black homeowners have the lowest housing equity at $123,000, compared to $251,000 for older white homeowners, $200,000 for older Hispanic owners, and $270,000 for older owners who are Asian, multiracial, or another race, say the authors.

The report’s findings indicated that mortgage debt among older adults is rising, noting that between 1989 and 2022, the share of homeowners 65 to 79 with a mortgage increased from 24 to 41%, and the median mortgage debt shot up over 400%, from $21,000 in 1989 to $110,000.  Over 30% of homeowners age 80 and over are also carrying mortgages, up from just 3% three decades ago.

“Borrowing is often a way for older homeowners to access cash for basic needs or care,” says Chris Herbert, Managing Director of the Center. “Given the importance of housing equity later in life there is a real need for safe and affordable mortgage products that work for older owners with limited incomes,” says Herbert.

The report’s authors suggested that financing incentives could provide better opportunities for those who wish to remain in their communities, but in more suitable homes; this would be particularly welcome in rural and other low-density areas where the choices are especially limited.

Climate change impacts housing

Finally, the growing threat of climate change is impacting older homeowners. The report’s authors noted that some states long favored by older adults because of their warmer weather are increasingly experiencing extreme heat and harsh storms. In addition to health risks, property damage is a rising concern, particularly for the increasing number of older people without insurance. “Severe storms in Florida caused $228 billion in property damage from February 2020 through April 2023, a state that is home to 8.3% of the nation’s older population,” says the report.

Tackling the senior housing crisis in Rhode Island

“Accessibility and affordability of housing has reached a crisis level, impacting all age groups. This excellent report from the Joint Center for Housing Studies at Harvard University confirms that the impact on older Americans is particularly acute. That is why my focus on housing issues is at the top of my agenda, and why I am fighting so hard to pass legislation encouraging the development of accessory dwelling units (ADUs), the number one priority of AARP.  The Harvard study makes it very clear that the need for housing and housing-based care for older adults is growing at an alarming rate, and in Rhode Island, I am dedicated to increasing the availability of suitable housing opportunities for our older residents,” says House Speaker K. Joseph Shekarchi (D-Dist. 23, Warwick).

“The housing report provides comprehensive information on the significant challenges related to the housing needs of older adults. The challenges in Rhode Island are amplified by an old housing stock usually lacking accessibility features and our low rate of housing production,” says Maureen Maigret, policy advisor for the Senior Agenda Coalition of RI.

Maigret, a former Director of the former Department of Elderly Affairs, identifies one particularly relevant section of Harvard’s Housing Report that discusses dual problems faced by older adults with both housing and support needs and how few have the financial means to pay for both housing and even a small amount of home care. This is important for Rhode Island with its high costs for long term care and a growing older population.

The Senior Agenda Coalition of RI (SACRI) applauds House Speaker Shekarchi and so many members of the legislature, specifically for their intense efforts to address the state’s housing needs, says Maigret. “We support the Governor’s budget proposal for a $100 Million Affordable Housing Bond issue but recommend the amount be increased along with an increase in the suggested amount of funds for priority projects for vulnerable populations including economically struggling seniors from just $7.5 Million of the bond dollars,” she says.

SACRI also supports legislation to ease development of ADUs, proposals that include accessibility features in new housing production, continuing the state Home Modification grant program and increasing the income cap for the state Property Tax Relief program, a program that helps both older homeowners and renters) to $50,000,” she says. 

ADUs and the Ocean State

Last week, Senator Victoria Gu (D-Dist. 38, Westerly, Charlestown, South Kingstown) introduced S. 2630, that would allow homeowners to develop an accessory dwelling units (ADU) within the existing footprint of their structures by right, or build an attached or detached ADU if the lot is large enough. This is the companion bill to the one introduced in the House.

ADUs, sometimes referred to as in-law apartments, backyard cottages or “granny flats”, are accessories to existing housing, created as a conversion of part of a house (such as a walkout basement), an attachment to a house, a garage conversion, or a smaller, detached dwelling. They have become increasingly popular around the country in recent years as states and municipalities balance the need to create more housing with preserving the character of residential neighborhoods.

Seniors, especially, have taken to ADUs as a way to downsize while continuing to stay independent in the community. Now the Senate is poised to pass legislation to boost ADU development.

S. 2630 is similar to H 7062, sponsored by Rep. June S. Speakman (D-Dist. 68, Warren, Bristol) which passed the House on Feb. 14, but it differs primarily in how it allows municipalities to apply several code regulations.

If the Senate passes an ADU bill this year, lawmakers will have an opportunity to reconcile the two bills, either passing the house or senate version, or reconciling them somewhere in the middle, or making changes that aren’t in either. Lawmakers must now compromise, on behalf of their older constituents to hammer out legislation for Gov. Dan McKee to sign into law. This would be a first step in tackling the Senior housing crisis in Rhode Island.  It’s a no brainer – and passing it this year is critical to addressing the crisis in housing.

For a copy of Harvard’s Housing report, go to https://www.jchs.harvard.edu/housing-americas-older-adults-2023.

ADU legislation sailing through lower chamber

Published in RINewstoday on February 5, 2024

With the strong support of House Speaker K. Joseph Shekarchi, one of nine cosponsors of H. 7062,  last week the House Committee on Municipal Government and Housing approved a legislative proposal that would be a boost to housing production by helping Rhode Islanders to develop accessory dwelling units (ADUs) on their property. The legislative proposal was approved on a partisan vote of 10-2 with Rep. Brian Newberry (R-Dist. 48, North Smithfield, Burrillville) and Rep. Patricia Morgan (R-Dist. 26, West Warwick, Coventry, Warwick) voting nay. The legislative proposal is expected to be considered by the full House of Representatives the week of February 12.

ADUs (Accessory Dwelling Units), sometimes referred to as in-law apartments or granny flats (not a term we like), backyard cottages, or secondary units, are accessories to existing housing, created as a conversion of part of a house (such as from a walkout basement or garage), an attachment to a house, or a smaller, detached dwelling. They have become increasingly popular around the country in recent years as states and municipalities balance the need to create more housing while preserving the character of residential neighborhoods. 

Seniors, especially, have taken to ADUs as a way to downsize while continuing to live independently in their community. The bill was written in collaboration with AARP Rhode Island, for whom increasing production of ADUs has been their primary policy goal for several years.

While being a relative is the most common relationship, it should not be a necessary one, with short term rentals are not allowed so ADUs do not function as BNBs. Also, while most commonly intended for seniors facing limited incomes and downsizing needs, ADUs are also popular with professionals or adult children.

Encouraging the development of Affordable Housing

H. 7062, introduced by Rep. June S. Speakman (District 68, Bristol/Warren), chairwoman of the House Commission on Housing Affordability, would boost the state’s housing production by making it easier for homeowners to develop ADUs on their property.  It would give the property owner the right to develop an ADU within the existing footprint of their structures or on any lot larger than 20,000 square feet, provided that the design complies with local building code, size limits and infrastructure requirements.

The purpose of Speakman’s legislation proposal is to encourage the development of rental units that are likely to be more affordable than many other apartments, and also to provide opportunities for homeowners with extra space to generate income that helps them maintain ownership of that property.

Speakman said the legislation is a small but important part of the much broader effort that the Ocean State must adopt to encourage the development of affordable housing. Since its inception in 2021, she has chaired the Affordable Housing Commission, helping to achieve the passage of 17 bills to help address elements of the housing crisis over the previous two legislative sessions.

To ensure that this legislation achieves its goal of housing Rhode Islanders, it prohibits ADUs constructed under this provision from being used as short-term rentals, and streamlines the permitting process.

“We are experiencing an ‘age wave’ in Rhode Island: one in four people in our state will be age 65 or older within the next several years,” said Shekarchi, the bill’s top co-sponsor in a statement announcing committee passage of H 7062. “ADUs are a great way to give seniors more options so they can age in place. They empower seniors to remain in their own homes, maintaining their independence and privacy, with family members or others in close proximity for additional support if needed. And, with Rhode Island facing a severe housing shortage, ADUs are a great way to add more housing units to our supply without changing the character of a neighborhood. ADUs are a win all around,” he says.

“One of the drivers of our housing crisis is the low construction rate in Rhode Island. Our state has the lowest per-capita construction rate in the whole country,” charges Speakman, the primary sponsor of H 7062, who calls on local and state officials to be creative and be willing to allow construction of housing, particularly affordable, moderate, and small units like ADUs.

Increasing Housing Options in the Ocean State

“ADUs are an excellent option because they are generally affordable to build and to rent. Because they are small and often can be created without even altering the footprint of the existing building, they don’t change the character of their neighborhood. They are mutually beneficial to the renter and the homeowner, who can use the rental income to make their own homeownership more affordable, says Speakman,” stressing that ADUs can allow seniors to age in place, close to their families.

“We should be encouraging development of ADUs, because they offer another housing option for Rhode Islanders and a relatively simple way to make more units available in the near term and help ease the housing crunch in Rhode Island,” observes Speakman.

“Every Rhode Islander needs a safe home that they can afford, and the only way we are going to make that happen is to build more homes,”  adds Speakman, noting that the legislative proposal removes some of the obstacles to building ADUs while respecting municipal land use policies. “Our commission learned that there are many people in Rhode Island who already have space that they’d like to use in this way, but our laws make it complicated. We desperately need housing, so it’s in the public’s interest to make it easier,” she says.

Along with AARP Rhode Island, H.7062 has the support of numerous organizations and agencies, including the Rhode Island League of Cities and Towns, Rhode Island Housing, the American Planning Association Rhode Island Division, Grow Smart RI and Housing Network RI.

In the Upper Chamber

“I am happy to see my colleagues in the House again moving forward to allow more homeowners to utilize accessory dwelling units. ADUs offer the ‘missing middle’ – housing that is smaller, more affordable and smartly repurposes our existing buildings and garages,” says Sen. Victoria Gu (D-Dist. 38, Westerly, Charlestown, South Kingstown).  The Senator is poised to submit a Senate ADU legislative proposal for drafting this week

“Homeowners can be a part of the solution to the housing crisis by creating or converting a garage, basement or shed into an ADU and offering it as a long-term rental. Then they have the benefit of receiving some additional income or housing a loved one. It’s a win-win,” adds Gu.

Sen. Meghan E. Kallman (D-Dist. 15, Pawtucket, Providence), who championed ADU legislation in the Senate last year, is strongly committed to working with Gu, to see an enacted ADU law this session. “In a time of extraordinary housing shortage, we need to be creative. ADUs are excellent choices for seniors or young adults, and offer affordable options for people at different phases of their lives. As we saw in the RISD ADU design competition in January, such buildings can also be very beautiful. I’m looking forward to working with my colleagues in committee and in the chamber overall to get this bill across the finish line,” she says.

Ever since June 2023, a coalition of stakeholders, including housing advocates and the AARP, have met with Senators, including both Gu and Kallman, once a month to strengthen and clarify the ADU bill that the House passed last year. Most of the Senate revisions are technical, but there will be three key differences between the House version and the current Senate draft that must be ironed out. They are:  

•             Allowing municipalities to regulate owner occupancy for ADUs. For example, requiring the owner to occupy either the main house or the ADU.

•             Allowing municipalities to set minimum rental periods for ADUs that are longer than 30 days but not more than one year.

•             Prohibiting the sale of an ADU separately, in terms of ownership, from the main house.

A Final Note…

With enactment of ADU legislation to allow Rhode Islanders do develop this housing option on their property, lawmakers might consider taking a look as to how other states are providing grants to boost its production.  

According to the California Housing Finance Agency, new funding laws incentivize and promote the creation of ADUs by providing grants up to $40,000 to reimburse pre-development and non-recurring closing costs with the construction of an ADU. Pre-development costs include site prep, architectural designs, permits and soil tests, impact fees, property surveys, and energy reports. 

The House and Senate must work out their differences to pass ADU legislation this legislative session, sending legislation to send to Gov. Dan McKee to sign into law.  Lawmakers might consider investigating best practices in other states, like California’s grant program, to make it easier to add much needed housing in Rhode Island. 

Editor’s Note: Reached late Sunday for comment on why she does not support this ADU bill, Rep. Patricia Morgan, wrote, “I believe that each municipality’s planning and zoning boards should have control over land use in their community. This legislation is taking away local control.”

To see testimony presented on Jan. 25, 2024, before the House Committee on Municipal Government Hearing on H. 7062, go to https://capitoltvri.cablecast.tv/show/167?site=1,

To watch the House Committee on Municipal Government and Housing’s vote and passage of H. 7062, held on Feb. 1, 2024, go to https://capitoltvri.cablecast.tv/show/196?site=1or. 

AARP report: States’ care for seniors “painfully inadquate”. Major gaps in RI

Published in RINewsToday on October 2, 2023

Last week, the Washington, DC-based AARP released its latest Long-Term Services and Supports (LTSS) Scorecard, calling care provided to seniors and persons with disabilities during the last three years after the COVID-19 pandemic “painfully inadequate.”  This nine-page report detailed state specific data, finds major gaps in providing care in every state, including Rhode Island, especially in these categories:  “Housing for Older Adults”, “Home Care Costs” and “Home Health Aide Supply”. 

The LTSS Scorecard, consisting of 50 indicators, focused on: affordability and access; choice of setting and provider; safety and quality; support for family caregivers; and community integration, using data from a variety of publicly available sources, such as the Centers for Medicare and Medicaid Services, American Community Survey, and Bureau of Labor Statistics.

Many benefits of accessing the data

According to AARP, this Scorecard can be a roadmap for improving the LTSS systems and the lives of those who rely on assistance.  Many others will benefit by reviewing this data, too. Federal, state, and local policy makers can identify priorities and ensure resources are allocated equitably. Aging advocates can glean public data and hold government officials accountable. Family caregivers can identify needed resources and become actively involved in policy discussions and advocacy. Seniors relying on long-term care programs and services can learn to inspire culture change and demand available tools. Finally, employers can improve workplace policies and practices to assist caregivers and healthcare groups so they can explore public-private partnerships and alliances. 

Like the findings reported in AARP’s LTSS Scorecard in 2020, Rhode Island ranked 12th in the country in 2023, but this year’s Scorecard reveals that the state has made some progress in improving care options for older Rhode Islanders, specifically the enrollment in the Program of All-Inclusive Care for the Elderly (PACE), as well as the availability of Adult Day Services.

“The pandemic reinforced the need to strengthen long-term care for countless loved ones across the country, including here in Rhode Island,” said AARP Rhode Island State Director Catherine Taylor in a Sept. 28th statement announcing the release of the 2023 LTSS Scorecard. 

“AARP’s Scorecard shows that there are many roads to meet the needs of all Rhode Islanders who deserve the very best care, including the 121,000 family caregivers in our state. The overwhelming majority — 87% — of Rhode Islanders age 45+ would prefer to receive care for themselves or loved ones at home with caregiver assistance. Yet, our low rankings in Housing for Older Adults (51st), Home Care Costs (43rd) and Home Health Aide Supply (41st) underscore how difficult it is for them to age the way they choose. It’s time to accelerate our efforts, for the sake of saving more lives,” she says.  

RI is dead last in housing

“In particular, Rhode Island’s dismal ranking for Housing for Older Adults – dead last – points to the urgent need to increase the supply of affordable, accessible housing. We can do that by passing legislation early in 2024 to strengthen homeowners’ ability to build an accessory dwelling unit (ADU) to allow them to age in place, support a family member, or house a caregiver,” Taylor said.

A national snapshot of the LTSS Scorecard’s 2023 Data

According to Scorecard, 12 states, including Rhode Island, have enacted paid family leave laws and 18 states have paid sick day laws, which can be used to assist caregivers. AARP’s latest Scorecard also reported that only 6 states provide a tax credit for family caregivers’ out-of-pocket expenses. Rhode Island does not provide a tax credit – nor is it among the 7 states that have statewide laws protecting caregivers from discrimination in the workplace that ensure they are not unfairly treated due to caregiving duties outside of work.

Meanwhile, it was reported that dozens of states experienced declines in the number of care choices that help support family caregivers. For instance, 16 states, including Rhode Island, had declines of 10% or more in access to home health aides since 2019. 

Regarding Home and Community-Based Services (HCBS), the LTSS Scorecard reported that 11 states, including Rhode Island, had state policies that improve presumptive eligibility for Medicaid HCBS at the time of data collection, making it possible for people to go home to receive care after being in the hospital – rather than having to be admitted to a nursing home while their eligibility for Medicaid payments is being determined.

The research indicated that many states also have large numbers of people with low care needs living in nursing homes, indicating a lack of HCBS access and services. More than 20% of nursing home residents in Rhode Island have low needs – compared to 9% nationally.

Data confirms Major Workforce Crisis in nursing facilities across US

As to nursing homes and institutional care, the AARP’s 2023 Scorecard confirmed that a  major workforce crisis exists in facilities across the country. Across all states, wages for direct care workers are lower than wages for comparable occupations, with shortfalls ranging from $1.56 to $5.03 per hour. In Rhode Island, wages are $1.79 lower than other entry level jobs.   

Nationally, more than 50% of nursing staff in nursing facilities leave their job within a year (53.9% turnover rate). However, in Rhode Island, the rate is slightly better than the average, at 49.3% – with Montana, Vermont, and New Mexico experiencing the highest averages in staffing turnover.  

Staffing disparities are also a significant challenge, say researchers, noting that residents of nursing facilities with high admissions of Black residents receive almost 200 fewer hours of care per year compared to residents of facilities with high admissions of white residents. 

According to the LTSS Scorecard, only 22% of nursing facility residents live in a facility with a 5-star rating in the US – with less than the national average, about 20.2%, of Rhode Island residents living in a 5-star facility. Gaps in workforce and equity result in persistent problems in care, say the researchers. One measure, pressure sores, can be life-threatening as they can lead to bone or joint infections, cancer, and sepsis. In this measure, 10% of facility residents nationwide experienced a pressure sore.

Finally, this year’s Scorecard announced that there is progress being made to create innovative and effective alternatives to traditional nursing facility models. Specifically, the researchers say that 10 states, including Rhode Island, made strides in nursing home innovations, such as by utilizing Green House® Nursing Home availability and policies, which includes small facilities, private rooms, and other best practices.

AARP’s 2023 LTSS Scorecard identified recommendations that can fix the nation’s delivery of long-term care programs and services to enable seniors to age in place in their communities. It called for increasing support to the nation’s 48 million family caregivers, “who are the backbone of the long-term care system, providing over $600 billion in unpaid care, such as with paid leave, tax credits, and other mechanisms to address health and financial needs.”

AARP Rhode Island continues to call on the Rhode Island General Assembly to support the state’s 121,000 family caregivers by advocating for enhancements to the state’s Temporary Caregivers Insurance program.

Recommendations on enhancing Long-Term Services and Supports

The Scorecard’s recommendations also called for investing in states’ Home and Community-based Care Infrastructure, by increasing support and training for home health aides and home visits, supporting the ability to access and use medical devices and equipment, and updating key Medicaid regulations and payment models.  

To tackle the workforce crisis, a recommendation suggests that it is crucial to support both nursing facility and in-home workforce by improving recruitment and training, increasing pay, and expanding the ability of trained nurses, aides, community health workers and other paraprofessionals to take on some aspects of care. States can choose to enact and enforce staffing and related care standards.

A recommendation also calls on States to expand the use of innovative, effective models for nursing homes can improve both quality of care and quality of life, such as with smaller facilities and private rooms and to address inequities by investing to close the staggering gaps in access to quality care and facilities and staffing shortages.

(Editor’s Note:  During the pandemic, then Governor Gina Raimondo allocated $5 million towards 2 changes in nursing homes – making all rooms private and providing non-shared, private bathrooms – for all residents – efforts to follow up on this effort have not resulted in what happened to that initiative according to the RI Department of Health).

Another recommendation urges states to create multisector plans for aging and building of coalitions and age-friendly health systems, to help seniors to age in place at home by having affordable and accessible housing and transportation, improved community design, and comprehensive emergency preparedness plans.

Researchers also suggested the advancing innovation in cities, counties, and states by supporting comprehensive state- and community-wide aging plans and piloting new approaches and programs, like Green House® Nursing Homes and presumptive eligibility, that can then be scaled.

Finally, Climate Change is increasing national disasters, and the LTSS Scorecard recommends that every state have a sound emergency preparedness plan to support nursing home residentsin particular, in times of crisis – including natural disaster.

“AARP’s LTSS Scorecard shows some progress and innovation, but there’s still a long way to go before we have systems that allow people to age well, and independently, for as long as possible and support the nation’s 48 million family caregivers. It’s also clear some emerging issues deserve more attention – from whether nursing homes are prepared to confront natural disasters, to whether they have plans in place to maintain and grow their workforces,” says Susan Reinhard, Senior Vice President, AARP Public Policy Institute.

The LTSS Scorecard is a charitable project made possible by a grant from AARP Foundation, with support from The SCAN FoundationThe Commonwealth Fund, and The John A. Hartford Foundation, and has been updated every three years since 2011.

To view the full Scorecard and state-by-state information visit https://ltsschoices.aarp.org/ 

To view the Scorecard for specifically Rhode Island, go to:  https://ltsschoices.aarp.org/scorecard-report/2023/states/rhode-island.

To view Previous Scorecards (2011, 2014, 2017 and 2020) go to https://ltsschoices.aarp.org/scorecard-report/report-archive/