COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE ON PUBLIC HEALTH AND HUMAN SERVICES AND HOUSING, NEIGHBORHOOD DEVELOPMENT AND THE HOMELESS - - - Room 400, City Hall Philadelphia, Pennsylvania Tuesday, December 2, 2008 1:20 p.m. - - - PRESENT: COUNCILWOMAN MARIAN B. TASCO, CHAIR COUNCILWOMAN JANNIE BLACKWELL COUNCILMAN WILLIAM GREENLEE COUNCILMAN CURTIS JONES, JR. COUNCILWOMAN MARIA QUINONES-SANCHEZ COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN JAMES KENNEY RESOLUTION 080735 - Resolution authorizing the City Council's Committees on Public Health and Human Services and Housing, Neighborhood Development and the Homeless to hold joint hearings on how the Aging in Place model could strengthen Philadelphia neighborhoods... - - - V A R A L L O Incorporated Litigation Support Services Eleven Penn Center 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.2670 2
Good afternoon. I'd like to call the joint Committees on Housing, Neighborhood Development and the Homeless and the Public Health and Human Services Committee of City Council to order. Today we're here to have a hearing on Resolution 080735, and we will ask the Clerk to read the resolution.
Resolution No. 12 080735, authorizing the City Council Committees on Public Health and Human Services and Housing, Neighborhood Development and the Homeless to hold joint hearings on how the Aging in Place model could strengthen Philadelphia neighborhoods by providing supports and services to seniors in their own homes.
Thank you very much. This is a resolution that was introduced by Councilman Curtis Jones and supported by all Councilmembers, and as the lead member and is his resolution, he 3 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 will carry the day. So I now call on Councilman Jones for comments, opening comments.
Thank you, Madam Chair, Councilwoman Tasco. Councilwoman Blackwell is going to join us. I want to thank you for having joint hearings on the Committee on Public Health and Human Services and the Committee on Housing, Neighborhood Development and Homelessness. Senator Edward Kennedy said yesterday at Harvard when he received an honorary degree, Senator Kennedy being one of our more prominent senior citizens in this country, said that our future will live far beyond us, but we will live within the future that we create. And in that spirit, Aging in Place, in my opinion, is a time concept whose time has come. My mother-in-law, Carolyn Lee, who had a fruitful career in education, 4 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 was a teacher in West Philadelphia, lived in the Northwest section of Philadelphia, one day realized that she could no longer drive across Philadelphia to be a school teacher and decided that she was going to call it a career. At that point, she made a decision whether or not to downsize her living quarters and move into an apartment, a small apartment, or to work it out in a way where she could stay in a home around family members, around people who she knew, loved, worked and played around. She decided to stay. , worked at 8th and Buttonwood as a laborer in the garment industry, worked all his life and was stricken with an aneurysm, which stopped him from being able to go to work every day -- he's probably watching these hearings intently as we speak, so I'd better get it right -- has decided too to not move out of his home in his community 5 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 that he has lived in since birth and he decided to stick and stay. My mother, who worked at the Naval Supply Depot for 44 years, worked there and retired from there, went on to what is called an encore career to be a teacher's assistant, not caring about the money, not caring about anything else, but wanted to fulfill the rest of her career by adding to the lives of young people, and, more importantly, she got bored after retirement and wanted something to do. I raise these things because this is a growing trend where people who have decided consciously not to go into assisted-living facilities, not to go into senior centers, but to stay in their homes and around their loved ones, in neighborhoods that they grew up in, raised families in and paid taxes, as importantly, in. As the baby boomers of our generation quickly, quickly move into the 6 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 senior realm in the fourth quarter of their life, as our demographics change in Philadelphia and, in particular, the Fourth Councilmanic District, it would be irresponsible of this City, we would not be good stewards if we did not begin to plan to make it more comfortable for our seniors to live and work in place and stay in their homes. Today's hearings will have a wide range of issues. Some of them will cover non-traditional issues, something old, something new, something borrowed, something blue. We'll look at the issue of healthcare and how it is provided to seniors and take into account new technologies such as telemedicine. We'll look at crime and how it impacts our senior citizens and whether or not we're doing enough by way of Special Crimes Unit that address white collar and blue collar and violent crime. We'll look at how our seniors socialize and whether or not it is a 7 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 mental health issue. Socialization has, since the beginning of time, been a human factor and important to our growth and development as individuals and as a society. We'll look at nutrition and whether or not -- I saw an article 9 recently that talked about that one out of 25 households has made a conscious decision to cut down on food intake as a result of the recession. We'll look at transportation. We'll look at encore careers.
We will look at filling the skills gap as we look at an aging population that's going into retirement without a developed workforce to take its place. My grandfather said that as he is, some day we would be, and he was right. Grand-daddy wasn't wrong. And with that, I'd like to welcome everyone here and, Madam Chair, say that I'm looking forward to a lot of good questions and a lot of great 8 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 answers, and thank you for all attending.
Thank you very much, Councilman Jones. And certainly this is a timely issue for some of us here at this table in reaching that age and have been thinking about some of the same issues that you will discuss today. So it is appropriate. The City of Philadelphia is a city made up of many older citizens, and whatever this Council comes up with in order to make the quality of their lives better, I think it would be fine, and we appreciate your leadership on this issue. Let me recognize those who are at this table, which I should have done first. I recognize Councilwoman Blondell Reynolds Brown, Councilwoman Maria Quinones-Sanchez, Councilman Greenlee, Councilwoman Jannie Blackwell, who is the Chair of the Committee on Housing, Neighborhood Development and the Homeless, and Councilman James Kenney. Other Councilmembers, as they come, will 9 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 join us during the course of this afternoon. Are there any comments from members of the Committee who would like to make comments before we begin the hearing? (No response.)
We will listen to your testimony. We have six panels. The panels will come forth, identify yourself, make your testimony. At the end of the testimony of the panel, the Committee will ask questions based on your testimony and maybe questions that we have that you might not have addressed. So we first call our first panel, Celeste Zappala, who is Executive Director of the Mayor's Commission on Aging; David Nevison, Associate Executive Director for Planning and Development, Philadelphia Corporation for the Aging. (Witnesses approached witness table.) 10 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
Good afternoon. Would you state your name for the record.
I'm Celeste Zappala. I'm Executive Director of the Mayor's Commission on Services to the Aging, and I am grateful to be here today, Councilwoman Tasco, Councilwoman Blackwell, Councilman Jones and members of the Committee. I hope you have my testimony, and I thought to be brief so that I could give space to all of my colleagues here. I am Director of the Mayor's Commission on Aging, and we serve older citizens in Philadelphia, and our goal is to try to improve the quality of life for older Philadelphians, and particularly serving low-income seniors who are 55 and older seeking to find employment and training. The City of Philadelphia offers services to older adults through several 11 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 departments, including Recreation, Housing and Public Health and the Office of Emergency Services. Our Commission works collectively with other departments to meet the needs of older adults, as well as working with the Area Agency on Aging and the many non-profit aging organizations, many of whom are here today. Ensuring that older adults can remain independent and healthy and productive is a goal of all of the organizations that are here. There are numerous committees and task forces that have been working to identify resources within specific communities to assist older adults so that they can remain in their homes or enable them to remain within their familiar neighborhoods. I'm sure today you're going to hear about the Naturally Occurring Retirement Communities, known as NORCs, and they are places within neighborhoods where many older adults live in 12 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 concentration and they wish to stay there and they can be served there through concentrated services in the areas. I want to tell you that beginning in July, the Commission, my Commission, and more than 8 organizational members have met through 9 the auspices of the Health Department, 10 the Public Health Department, and the 11 Aging Task Force, and its aim is to 12 enable older Philadelphians to remain in 13 the setting of their choice, to improve 14 their quality of life, and to have senior 15 citizens actively participating in 16 services they receive. The Task Force's 17 goal is to enhance the quality of life by 18 utilizing community-based services for 19 the elderly and to prevent isolation by 20 enabling older Philadelphians to stay 21 involved in their communities. 22 Ensuring that older 23 Philadelphians are free from abuse and 24 neglect and exploitation and abandonment 25 is another goal of the Public Health 13 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 Aging Task Force. Strengthening protective services will prevent the abuse of older citizens, and that's essential, as is educating seniors on steps that they can take to ensure their own safety. Inherent in all of these strategies is the promotion of consumer self-advocacy. And as we in the provider sector consider the needs of elders, the elders amongst us, of which many of us are one, we have to be sure to incorporate their voice, their needs, their strengths and their wishes. I wanted to say to you that on November 14th, many people here were at the Farnese Symposium: Aging in Place - Can We Meet the Challenge. Many parties were there. And we all know that remaining in a home is often the goal of older adults, and as your resolution 23 states, there are insufficient resources available to sustain necessary physical assistance and home repairs. The 14 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 majority of those services are supported by funds from the State, and as we discussed at the Farnese Symposium, the State is and must be an active partner in successfully creating solutions to strengthen these services.
Older adults are a growing resource within our City, and as such, Philadelphia, the city of neighborhoods, can draw on the talents of its long-time residents, as well as work to create comfortable options for their continued presence. Older Philadelphians are as diverse as the City itself. There is no 16 single model that will accommodate the needs of all older adults. However, it is indeed encouraging that the Council will explore and promote solutions through this resolution. The Mayor's Commission on Services of the Aging will continue to participate in development of solutions for aging in place, grapple with the obstacles, and collaborate with the 15 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 ever-growing aging network in Philadelphia as we collectively try to map away to create a healthy, supportive environment for our older citizens. Thanks for this opportunity to testify. I'll be happy to answer any questions that you might have.
Thank you very much. The Chair recognizes Councilwoman Blackwell.
Thank you. Ms. Zappala, we wanted to acknowledge your leadership and advocacy in many fields. I see Ms. Zappala around the City in many issues, both dealing with those here and abroad, and we thank you for your commitment to people.
Shall I begin? 16 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
My name is David Nevison. I'm Associate Executive Director for Planning and Development of the Philadelphia Corporation for Aging, and it's a pleasure to be here today, and I'm very appreciative of the Council's focus on the needs of older people. As the Area Agency on Aging for Philadelphia, Philadelphia Corporation for Aging, or PCA, touches the lives of over 100,000 older persons each year and contracts with over 130 agencies to provide health and social services. PCA assesses the needs of older persons, and through planning, advocacy, information and education, contract administration and direct service provision helps address those needs. Thus, the agency is in a unique position to understand the current gaps and coming needs of senior citizens. We are connected to the entire continuum of care, and we serve as a hub for aging services in the community. In 17 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 an environment of limited resources and complex needs, it is crucial that services be efficiently managed and coordinated. Aging services and our understanding of the needs of seniors have grown increasingly sophisticated over the 35 years since PCA was created and in the 34 years since I've been at PCA. However, we are now at a critical turning point. Our population is becoming more diverse in many ways and more complex in terms of its healthcare needs. The need for services is increasing, both because of increasing numbers of seniors and because the numbers of frail elderly with multiple conditions are on the rise. Philadelphia is in some ways unique and in other ways similar to other urban areas in the State, both large and small. The needs of our seniors are tremendous and growing, beginning with the roofs over their heads. More than 70 18 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 percent of Philadelphia's seniors own their own homes, but those homes are crumbling around them. There are insufficient resources for repairs and an inadequate supply of affordable and accessible housing. In fact, elders living in Philadelphia report significantly more need for home repair than those in any of the four surrounding counties. And while I didn't put it in my testimony, the challenge of seniors heating their homes is really a major challenge for many of them, given there are not always well-functioning furnaces and lack of proper insulation and weatherization. The proportion of elders living in poverty in Philadelphia is 20 percent, as compared to 11 percent statewide. Older Philadelphians are also much more likely to live alone and to exhibit personal care needs than elders elsewhere in the Commonwealth. 19 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 Philadelphia has a growing minority population, which projections indicate will comprise 60 percent of the older population by 2025. In addition, more than six percent of both our minority and non-minority elders currently experience linguistic isolation. Language and cultural barriers further complicate the service delivery process, and a much larger multi-lingual workforce will be needed than presently exists. Minority groups on the whole experience higher rates of poverty, lower education levels, inadequate housing and poor nutrition, along with a lifetime history of poor medical care. As this population ages, health deteriorates more rapidly, and individuals are more prone to chronic illnesses, such as cardiovascular disease, asthma and diabetes. In the coming years, we will have more elders reporting a lengthening 20 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 list of chronic ailments. Not only can people live longer with such illnesses as diabetes and COPD and with diagnoses that indicate severe impairment of functional health, such as arthritis, but other disorders such as HIV infection have become chronic illnesses, meaning that the health status of many elders will become increasingly complex. The incidence of dementia is expected to increase as well.
It should be noted that caring for grandchildren has also increased the burden on older people. We estimate that 5,000 elders have cared for a grandchild for six months or more. Of those, 95 percent are members of a minority group, and a third have incomes below the poverty level. At the same time as we face increasing service challenges, we are encountering serious financial shortfalls. Over the past several years, PCA and its service providers have 21 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 experienced effectively flat funding. With the current economic crisis, we are deeply concerned about the prospects for the future. If funding remains flat or diminishes in the face of increasing needs, we will be looking at a disastrous situation. This is complicated by the Pennsylvania Department on Aging's intrastate funding formula, which undervalues the impact of minority status and poverty on service needs in the way they calculate funding allocations. PCA serves more than 5,100 seniors in the Over 60 Medicaid Waiver program, providing care that enables them to remain at home. However, there are long waiting lists for the Options in Home program, which are supported by the Pennsylvania Lottery. Two years ago, there was a significant Lottery surplus. Instead of using that to adequately fund programs such as Options, legal services and senior centers, the State opted to use the money to balance the budget. 22 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 Research shows that seniors remain healthier longer if they are able to remain in their own homes and in their own communities. It is also more economical for them to do so than for them to move to a nursing home. This means providing sufficient funding for home and community-based services and for the constellation of services in the community. Older people also need neighborhoods that are supportive of them. We asked our Milestones readers what would make their neighborhood a better place in which to live. Seven hundred older persons responded to the survey and repeatedly asked for safer streets, including better lighting and more police presence, to get rid of gangs, to build better and stronger relations among their neighbors, to see a grocery or restaurant or other business move into their neighborhood and to get rid of the trash and litter they see 23 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 every day on their block. City policies, whether it's zoning or public safety or transportation or taxation, have a profound and unappreciated impact on older people and their ability to function in and feel supported by their neighborhood. Pedestrian issues, like the timing of traffic lights and broken sidewalks, affect walkability and are important quality of life elements. All of these policies should be evaluated with the needs of the elderly in mind. It is also especially important to educate the community and to develop connections, informal supports and collaborations to strengthen the safety net for all seniors. We need to encourage neighbors to help neighbors and neighborhoods to support their older residents. PCA is working towards these goals through a public education campaign and through initiatives to link senior centers, faith communities, block 24 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 captains and other community organizations and to create collaborations that enhance the lives of both seniors and the community as a whole. Social capital, how one feels about their neighborhood and their community connectedness, has been shown to contribute significantly to the psychological and the physical well-being of older persons, whether they're healthy or frail. When the growing diversity within the population is combined with the increasingly complex health and social conditions experienced by many elders, we face a very challenging future that will require serious rethinking of current models for care.
In closing, rather than an Aging in Place model mentioned in City Council's resolution, City Council may want to consider an Aging in Community model, which includes the broader 25 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 community context in which the older person lives and which has so much to do with their quality of life. Thank you. I wanted to indicate that I've added some attachments, including charts from an area plan, which kind of focus on the impact on poverty and race on need, as well as Councilman Jones asked for a breakdown by City Council district. That's a bit of a challenge given the boundaries of City Council districts, but I did include a chart that we just prepared by neighborhoods, by about 16 neighborhoods, with a number of different 17 characteristics that might be helpful, 18 and an ad that will be running in 19 community newspapers that gives an 20 indication of the kind of education that 21 we're going to try to promote about 22 neighbors helping neighbors. 23
Sure. Go 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 ahead.
Thank you for working on the demographics I asked for by Council district, but what I've learned as a freshman Councilman, sometimes we ask questions we already know the answer to, and one of them is that the Fourth Councilmanic District has the highest number of seniors of any other Council district, which brought me to the conclusion that we really needed to have these hearings. We share that common interest in seniors, all districts, but in particular in the Fourth District, because of a lot of the gravitation to senior facilities as well as a lot of social agencies that are clustered in the Fourth.
Thank you very much. I just have one question to ask both of you. Do you provide services in the neighborhoods to your seniors? Do you have neighborhood offices or would 27 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 senior citizens have to come downtown to access your services? Both of you.
For the Commission, we only have one location. So we are at Broad and Chestnut, and we don't have any office in the communities.
Do you provide programmatic activity in the various neighborhoods?
For our Commission, we have an employment program that places low-income elders in community service organizations, and they get job training through that. And then we have an education program for Medicare and Medicaid where we do go out and try to help people at various senior centers. If you think of the outreach, though, that occurs through the Recreation Department's senior centers, that might be another way to reach people, because there are funded senior centers through the City of Philadelphia and they do have social workers and they 28 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 do help and assist people who come into them in the neighborhoods.
Most of the services that we're involved in are services provided through agencies with whom we contract. What we do directly is home repair, information and referral, case management, and those services are all centrally housed in one location. We also deliver home-delivered meals out of a separate commissary that's also a central location.
So if someone would want to access -- you have other agencies that you contract with such as?
Yes. I mean, we have over 130 agencies, whether it's operating senior centers or legal services or employment services or a variety of other programs, and in many cases, older people would directly 29 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 contact those agencies or they can contact us and we would either refer them or directly connect them with those agencies.
Okay. Thank you. The Chair recognizes Councilwoman Brown.
Thank you. Good morning to you both. Let me first join Councilwoman Jannie Blackwell in saluting the work of your office, Ms. Zappala. This is a unique opportunity for me to thank both you and the Philadelphia Corporation of Aging. Your representative, Gail Garrett, who for several years now joined with my office in doing exactly what Councilperson Chairwoman Marian Tasco has raised, and, that is, outreach. By way of background, when I first came here, I discovered by calls on the phone that seniors are actually intimidated to come downtown and walk 30 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 this massive building for services that they need. So our way of responding was to take services to them at various senior centers around the City, the largest of which is in Councilwoman Tasco's area where there's always a huge number, and we bring City agency representatives and non-governmental representatives to seniors in the comfort of their senior centers, and that has worked enormously. So I thank your agency reps for that. And this is a unique chance for me also to say thank you for facility heads like Angela Brown of NewCourtland and others, who allow us to bring this tour of agencies to the community, in the trenches, up close and personal with seniors. One of my discoveries in doing that has been a lot of what I observed also when I first came around here around services to children and youth: lack of coordination. There's been tremendous 31 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 improvement in agencies talking across and with each other and also agencies talking with those outside of government as it relates to serving children. I see similar challenges for this community, and so my question is, what grade would you give your world in how well you coordinate and talk across agencies in government and non-government when it comes to the very issue Councilman Jones has raised? I have a grade I can give based on my experience over the last five or six years, but it's my own editorial grade. What would be yours, since you live and breathe this every single day?
You know, I wouldn't give us all more than a C. Because there is this dichotomy of service, because the Area Agency on Aging is not the local government, so it's a difference and a structure that we work across all the time. Sometimes we work real successfully, sometimes we don't. People often assume that 32 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 they're going to get what they need from City government in terms of aging services, but that's not what exists if we have a different setup here in the City. So I think that the agencies all try to work hard with each other, but I don't think in terms of the grand planning that we could well do together between City agencies, between the State agency, between our non-profits, we could do better. We can do better. And we have more older people to try to support and inform, and just as you've recognized from being out there, what might seem to all of us to be kind of obvious or evident isn't to the person who is in the 12th Floor of the Senior Citizens Building, and how do we get there to make sure that their information and the resources they need are there and do they have a social service person in any capacity that they can turn to. So I think people are earnest 33 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 and they're trying, but we're not there yet, and I know that being with you in those experiences, you can see it in the questions that people ask.
I guess maybe a C, because it's obviously one of those things that is never going to be perfect and you have to continue to work on. The other thing is that you can think of coordination at kind of an agency structural level, but you can also think of coordination from the older person's standpoint, and those aren't the same things.
From the older person's standpoint themselves or from their family's standpoint, which is you can have agencies perfectly coordinated, but if it wasn't clear to the older 34 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 person how to access the system and to move from one part of it to another, ultimately you wouldn't have achieved your goal. And so I think we have to continue working on both levels. What we learned when we did our area plan this past spring with focus groups was, when we asked people what was their primary need, it was still information. In spite of all of the advertising, all of the public education, there was still information. And what they said was they needed it from trusted sources. It wasn't necessarily us. So part of our challenge -- and we've been working on it -- is, how do we get more information down to those trusted sources, to their clergy, to their block captains, to their community organizations, so that when they have a need, they turn to those people. We've also completely changed our website and developed other kinds of web tools to make it easier for agencies 35 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 to communicate with other agencies and for people to understand from each other what's going on so that they learn from one another and we all grow as part of the process.
Not too long ago Secretary of Aging, Ms. Dowd, had a press conference with the Mayor wherein they unveiled, if you will, something like a Benefit Bank.
Much like the Benefit Bank, Council Chair Lady. And so the discovery in that case was seniors who received a letter from the Mayor were more inclined to respond because of the trustworthy factor than a letter from anyone else in government. And they learned that seniors had been mailed a letter from agency representatives, didn't touch it, but the same letter mailed under the Mayor's signature made a huge difference. 36 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 So this issue of trust is extremely important. Kinship care. You mention that there are 5,000 grandparents. There are about 50,000 grandchildren currently being taken care of by their grandparents right here in Philadelphia today, and so with this growing phenomena, my question is, on this Task Force, is that one of the Task Force's considerations that the Task Force is looking at, Ms. Zappala, along with this issue of lack of coordination, which is blaringly clear, and are those issues on the Task Force in those proceedings?
As that Task Force has developed, that has been highlighted, but it hasn't yet, I think, received the kind of importance that it now has nor that it will in the future. The Task Force that the Health Department is moving along has broken into a number of committees, and the issues of grandparents raising grandchildren is 37 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 certainly important in that mix, but I don't think that there's any new answers that have been developed yet.
Is this aging in place committee on this Task Force, the aging in place as a challenge, as a --
Oh, certainly, yeah. That's kind of the -- I mean, the focus of that Task Force really is similar to what you're exploring and trying to recognize what components are necessary in order to help people to stay in their homes, to sustain themselves healthfully and to meet all those challenges that are coming to them and trying to coordinate with some of the many organizations that do provide services.
My final question, because I'm sure other members of the Committee have questions, what's the status of the Task Force and what next after the Task Force so that we get 38 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 something as a result of all that work?
Sure. The committees are supposed to reconvene in January, the committees that were established in September, and bring their recommendations back to try to see where that Task Force goes next, and that is, as I said, under the auspices of the Public Health Department.
So there is an expectation for implementation of some of those recommendations?
Point of information. Can you make sure that this Committee is informed, A, of when those meetings are?
All the members of this Committee. But, B, also progress that you made, to the degree that you are willing to share --
Oh, certainly. 39 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
In particular, on this subject matter, aging in place, that we be informed about that.
Absolutely. That would be -- maybe there would be a representative from the office who might want to attend. That would be great. Thank you.
Thank you, Madam Chair. First, I want to echo what other members have said about thanking you for the many years you have given, both of you, to help us seniors and obviously that means to the citizens of Philadelphia. So thank you.
Thank you. 40 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
I have a couple of questions. First, just to piggy back a little bit on what Councilwoman Reynolds Brown said about the grandparents taking care of grandchildren, have you seen any improvement at all? I know one of the complaints you hear sometimes is grandparents have problems getting the necessary benefits, the help, the economic help, in taking a care of grandchildren, maybe because the parent is somewhat still in the picture, even though really they're not, if I'm making you -- you understand what I'm asking?
And I would have to tell you, I'm not the expert on this one. But there are advocacy agencies within the City who work with grandparents. The Philadelphia Citizens for Children and Youth and the Senior Law 41 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 Center have both made supporting grandparents and their economic issues a part of their advocacy work. And, David, do you work with grandparents within --
As part of one of our programs, Caregiver Support program, a section of that is devoted to working with grandparents caring for their grandchildren.
I think it's an unmet need, though, and something that all the more you see, that there are people who are taking that responsibility and yet not getting the support from the community that they need.
Right. Yeah. I just had a real broad question and one more specific one. Particularly over the last few years, have you seen any particular issue or problem or one or two of them that have 42 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 come out that have made it particularly difficult for people to be able to stay in their homes? Is there anything to either of you that kind of jumps out?
Well, here's the thought: We live in this wonderful old city with lots of old houses, and our old housing stock requires a lot of support in order to keep it livable, and there just isn't enough money to do the repairs necessary and the weatherization necessary. As David mentioned, we know that people were struggling to heat their houses, but if they're not weatherized properly, they're just blowing money out the windows, right? So that, I think, is an enormously important issue that we have to think about in our old neighborhoods where we're encouraging people to stay and to live and enjoy their lives, but their houses are in --
They're not 43 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 livable houses. And then the other issue that people always talk about is transportation, that people have issues about transportation.
Anything else? Mr. Nevison, anything jumps out to you?
Well, actually, one comment I want to make about housing, which is that, as a comment, 70 percent of seniors own their own homes, but from a broader economic standpoint for the City, a significant proportion of Philadelphia's housing stock is owned by seniors, many of whom are losing the financial, physical or mental capacity to keep those homes up. So from the standpoint of the condition of Philadelphia's housing stock separate from an issue of the needs of the elderly, that that can be a major challenge for Philadelphia, which is a decline in the general housing stock that 44 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 can be very difficult to bring back if it declines below what the house is worth, which can happen very easily with some of these houses.
Sure. Sure. One last question. In his opening statement, Councilman Jones talked about crime, both white collar and otherwise. Have you seen those kind of concerns increase, decrease, about the same over time?
No. I would think in the past five or six years, there's been an increasing fear of street crime, fear of economic crime.
That's what I was really thinking about, the economic crime, because obviously, I mean, a lot of us have -- like Councilwoman Miller and I worked on that whole issue of stolen deeds and --
Right. I was just going to mention that. 45 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
And it seems like when we deal with that -- and our names have kind of gotten mentioned a lot to come and see -- a lot of those people are seniors. Unfortunately, often times victimized by family members. And I was wondering if you've seen any kind of increase in that, or I guess the flip side, any better solution to them as time goes on.
I think that what you mentioned, the issue of other family members, is such a tricky and difficult thing, because a lot of times people who are living alone and have a Social Security check become a target of their own relatives or friends, and it's very hard to intervene in those situations. It's hard to get the older person to admit that they're in a problem. The Corporation for Aging offers protective services for older adults, and they are able to step into exploitive situations, but sometimes it's 46 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 really hard to get that person to recognize that they are being exploited.
And want to admit it publicly that their grandchild or son or nephew or somebody is doing something. Obviously if somebody is stealing their house, obviously they can't live in place, because they don't have a house.
Just a comment about crime, which is, to some degree perception is reality. If an older person is afraid of street crime and they don't go out or they nail their windows shut to help protect themselves and, therefore, can't open the windows in the summertime, then whether there's crime in their neighborhood or not, they're suffering from the effects of that. 47 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
Thank you, Madam Chair. I'm going to yield to my colleague in the Seventh District.
Thank you. For me, it's some clarification on a few points. As it relates to the Task Force, what has been the role of the Department of Rec's older centers in the formulation of some of these discussions?
I would just like to sort of clarify that the Task Force itself started in July and hasn't done a lot yet, and the Public Health Department is sort of moving that along. But to answer your question, the senior centers across the City are a vital piece of how seniors continue to live healthfully in the City, and they are the outpost of service and relationships. 48 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
And communication. So, yes, the folks are there from the senior centers, but I think that there are many issues -- and I know they're going to be spoken to today -- about senior centers and the support that they need in order to continue those services.
Right. And that's important for us, because that is one direct way that we fund and support seniors maintaining their own homes and living within their communities. So I just want to -- was looking for your perspective on that to see if there's more that we could be doing there. I notice in your demographic information you only had it broken down between Hispanics and Asians, and I notice that the isolation rate, the linguistic isolation rate was over 50 49 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 percent for Hispanic and 56 percent for Asian. Is that broken down any further given the increase of other immigrants into the City, and is that data available anywhere, and if it is, where could we get it to the Chair? I'm very much interested. I have a growing Brazilian community, Russian community. I'd like to see if the numbers are as startling as those.
Well, I'm not sure that it's broken down any further. The reason why there's such a high number for linguistic isolation under white is because of the Russian and Eastern European immigrants, which is sort of one of the challenges when minority is used as a measure of need, and, in fact, there's some groups that from a linguistic and cultural standpoint provide extra challenges to service provision as well. So that's partly why 50 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 we kind of highlighted that percentage of linguistic isolation, which is about six percent overall for the entire community.
So in that subgroup, you would include those groups that I'm mentioning, Brazilians potentially, Russians? And I guess that's the point that I'd like to see clarified, just because we have so many different groups, and I'm very concerned of that number being so high, because that means folks can't even communicate. And then comes the question of how are you guys addressing that isolation, that language isolation for these groups.
Well, we're trying to do more through multi-language media, whether it's television or radio or foreign language newspapers. We're trying to hire more multi-lingual staff.
How many 51 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 languages are spoken within your agency from your workers?
I don't know. I know it's something that we continue to try to hire people who speak two or three languages. We also have -- I believe we're up to about five interpreters full time --
-- who work with -- I know Russian, some of the other Eastern European languages, Spanish and some of the Asian languages. I'm not sure actually which ones.
I'd be interested in those numbers just for information as part of this overall conversation. You talked about 70 percent of our seniors own homes, and we've also talked about the ones who are raising family. How many of those seniors who own their homes who are living in homes 52 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 live with extended families? Do we have any data? Are they living alone or do they have the daughter, the son? Do we have any way of knowing?
Well, we have information on living alone. We probably have some information on extended families. As I ask my Research Director on this, he would answer sort of, it depends, because we have some data, and some of the data that I included is from PHMC's elderly health survey. Now, that's a telephone survey, which tends to under-represent some minorities for people that couldn't really answer survey questions over the phone. And they're aware of that, particularly among the Asian population.
Of the 5,000-plus people that you serve on an annual basis, do you keep that type of information on them?
Oh, yes. There's lots of information on the older people 53 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 that we serve, subject to HIPAA regulations, et cetera, but certainly from an aggregate standpoint, we have a lot of information on those people we serve.
As we talk about housing and housing needs, it would be interesting to look at who is living in the household, what other potential sources of income are there, if that becomes a deterrent from them being eligible for other services. And I say that because I know instances where people have -- they do live in the house with the seniors, but they can't report it for failure of some eligibility issues. So I'd just be interested in looking at that. I know that culturally for other groups, minority groups, you may see more and more extended families, but I'm interested to see if that's actually being reported out or not. So thank you. 54 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
Well, as you continue your work, we would certainly be willing to work with City Council on trying to assemble data from a variety of sources that might be helpful in your deliberations.
Thank you, Madam Chairman. Couple of things. And I heard some very good comments from my colleagues, and it kind of opens a wide array of issues germane to not only the general public but particularly senior citizens. What I want to try to get back to is aging in place in the strictest sense, and I want to ask a couple of questions of you two, but any other panelist that comes up that can answer them, feel free. The question I have is, what is the cost differential between someone 55 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 living in an assisted-living facility or a seniors home versus the concept of aging in place? Has there been a study or any quantitative analysis to look at the cost comparisons between the two?
And then certainly home and community services would be less than that, but, again, it depends on -- that doesn't factor in the cost of the person actually living in the house and so forth.
And I know this will vary and it won't be an exact science, but if you were to quantify what services generally seniors need to live a good quality of life in the fourth quarter, how much does that cost batched together on a deliverable daily basis 56 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 versus how much it costs to provide it every day, the $80,000? So in your Task Force, one of the questions I would ask is, how do you analyze that and compare apples to apples? And we need to start doing those kinds of cost comparisons as a city, because we then are armed with data that becomes information on how we plan for a graying Philadelphia. So those are questions of today that need to be answered by tomorrow. The second thing that I would ask is, who keeps statistics on violent crimes and white-collar crimes towards seniors, and do you have that -- do you keep analysis of that?
We don't keep it. We kind of -- there's some data that we access from the City.
I think the District Attorney's Office and the Police Department.
So as we start to quantify where we deploy 57 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 personnel and if there are particular types of crimes that are germane to seniors -- and I've heard some horrific stories from seniors where they go to the MAC machine or they're at the grocery store -- there is a predatory pattern for even violent crimes that is germane to that, and if we know where these crimes occur and to whom, we can better deploy resources to protect communities that are graying. So as your Task Force evolves in its questioning, that's one of the areas I'd like to see you kind of keep track of, so you can kind of tweak us or the Mayor's Office, when needed, on how to deploy resources. How many seniors are there in the City of Philadelphia?
And we provide services to how many? 100,000 was it? 58 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
We touch the lives in one way or another of 100,000. That could be coming to a senior center. It could be calling up for information about services or help with benefits.
So there is a needs gap. What is the needs gap versus the funding for the hundred thousand versus the quarter of a million that exists?
Can I just make a point, sir, that all of those people interact with the services of the City of Philadelphia regardless of whether they're getting direct service through PCA and their kind of supportive services, but everybody as a citizen is affected by transportation and --
Let me ask you this. Let me follow that thought through. So every senior citizen in the City of Philadelphia who is hungry gets Wheels on Meals?
No, I don't 59 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 believe so. I mean, I know what you're saying, but -- no. There is a gap. Certainly there are people who for -- and we found that when we were doing the BenePhilly efforts, that people don't necessarily sign up for all of the things that they're entitled to and the benefits that they could have. Either they don't know of them or they find the system too complicated to approach.
Okay. So there is no senior citizen that is not getting proper healthcare?
So my question is not meant -- I tend to be a little more sarcastic than I should be, and I'll ease up. What I'd like you to contemplate is how we better provide services in particularly those two areas. There should not be a senior citizen in the City of Philadelphia that does not have the nutritional requirements that 60 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 they need, period.
There should not be a senior citizen at the point in their life where they need healthcare the most that does not get it. And so the quantitative analysis of how we provide these services is vital now. So as we start to look at testimony about telemedicine and other things, to do cost comparisons is going to steer our ability to apply limited resources within a shrinking budget. So we count on you to ask the tough questions. And sometimes we don't want to hear the answers, but we need to in order to better -- the issue of seniors is going to grow. It's not going to shrink. So we need to be prepared for that planning. You mentioned in your testimony that you subcontract with 130 agencies. Can you give us a description of some of those agencies? When we talk about 100,000 people with 130 agencies, help me 61 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 out to understand that.
We're talking about the City. We fund the Mayor's Commission.
We fund the Department of Recreation for a lot of the funding for senior centers, Philadelphia Senior Center, a lot of other agencies to operate senior centers, legal services, transportation.
Residential? No. 16 But we -- oh, well, we do fund certainly home care. A significant part of, probably more than half of our budget in our contracting, is for case management and for providing home care services.
And the reason I kind of want to know that is because, A, know I am so democratic, it's not funny. So it's not in my DNA to want to cut anything. If I had enough money 62 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 and if I ran the treasury, I'd fund everything there was. But in limited resources, we have to make tough decisions about duplication, who is doing the better service-providing than others, and that analysis where, again, I'm going count on you for. So as we start to look at and codify services to seniors, we want to know who has the best mousetrap and who is doing it better than others and what should those others aspire towards. So, again, kind of evaluating the service providers, a report card, if you would, is the kind of thing that we're going to -- I'm going to ask about and I believe this Committee is going to want to do. A couple of quick things and then I'm going to turn it over to the Chair. You said the number one reason for leaving I heard was sometimes home repair, and I agree with that. A lady in the Haddington area, for lack of a $5, 63 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 $10 wax ring around her toilet, had a leak in the toilet that resulted in a collapse of the ceiling, which resulted in the decimation of her kitchen, which meant she had to live.
We need to provide -- there's a program like The Other Carpenter and some type of handyman programs particularly for senior citizens who for lack of experience -- and one issue that I know my colleague is very keen towards, predatory lending on these home repair shysters that come around and say, Sign here, we'll fix your kitchen, for interest rates that only a loan shark could love, we need to be careful on how we filter our seniors into credible screening houses so that they don't get taken at the end of the day for their number one possession, which is their home. So we're going to rely on you 64 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 back and forth, two-way door, to try to codify all of these services, batch them in one place, get them to the people who have boots on the ground, if you would, in the communities so that people know about it. So we're going to ask the little different question in a different way, and maybe we'll get a different answer as we move on. Finally, to your knowledge, are there care provider programs that allow for a senior citizen to work with a younger member of their family to live in a duplex or shared multi-unit facility that they sign a social contract, an actual contract to provide services to the elderly person? So if I'm a senior citizen and I have a niece or nephew that is just starting out in an apartment above, that a part of the covenant would be that daily they have to make sure that I get my proper nutrition, daily they have to get my medicine in the neat little pill 65 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 cases that allow you to know when you're taking them, but are responsible for a checklist of things that daily or weekly they have to provide for them. Does such a service exist or program exist?
The State, I believe, is trying to support that kind of possibility for a relationship with caregivers. I don't think it's like totally worked out that that's -- I know in the last meeting we had with State representatives, there was discussion of how -- because that occurs in other places. It occurs in other states, but I don't know that our state has fully supported that idea yet.
Right. Not in the way they do it in Vermont. 66 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
There is more and more movement to create more and more options for people -- using other people in the community or using family members, subject to controls to make sure that that is not taken advantage of. One of the challenges to remember is that most of our money comes from the State, and some of the money that comes from the State actually comes from the feds. So at each stop along the way there are requirements and restrictions and limitations about how those funds are used, including giving older people the choice of home care providers in a way that limits our ability to restrict our funding to specific providers so that consumers have as wide a range of choice as possible.
Last question for me and this panel. If there was another city other than Philadelphia, other than Philadelphia, take us off the consideration, and you had to move 67 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 tomorrow and be a senior, what city would it be and why? Other than the weather. Don't tell me the weather in Florida.
We always say that Pennsylvania is a great place to get old in, because there are a lot of supports. There really are.
Because I think that their service structure, small state certainly, is maybe a little more -- has that kind of programming that you talked about of trying to bring -- people having a choice of their caretakers and that sort of thing. And the new Acting Secretary of Aging in Pennsylvania is from Vermont, so I kind of have hope things will improve. 68 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
I'll move with her, yeah. I'm a born and bred Philadelphian.
Let me just ask a question in terms of the federal requirements or restrictions. Has there been any effort to lobby our local federal congressional representatives to look at the federal laws that hamper your ability to provide services to senior citizens? You talked about money coming from the feds and the State and the restrictions that are placed on some of the funds in terms of the programmatic activities that you would like to provide but can't because of these restrictions. Have we talked to our congressional delegation about that to see that maybe they could do something 69 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 about it?
Well, in fact, Pennsylvania is lucky in that the majority of our funds come from the Lottery, that the -- it's a good thing we're not relying on the federal funds, because they haven't increased in probably years. So an increasing 10 share, more than half, maybe more than 60 11 percent, of our money comes from the 12 Lottery, and so most of the restrictions 13 are really placed by the State on how 14 that money is spent, not by the federal 15 government.
And our challenge is how much of that they give us. I mean, that's the bigger challenge than the restrictions on how it's spent. It's how they decide how to allocate that money from county to county.
So it's not solely targeted or solely committed to senior citizen services. There's some 70 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 flexibility that it could be used for other things? I notice in your testimony you said --
Balance the budget. Well, what the Governor has done is, since he had to spend the money for seniors, they basically combed the budget and looked for every place where they were using State funds, whether it was the Medicaid match for nursing home or home care or administrative costs for the Department of Aging or other places that were previously funded using regular State funds and they replaced those with Lottery funds, freeing up the State funds to balance the budget.
Do you think that will occur again? Is that going to be the norm?
Well, they may be running out of places to do that with, and I'm not sure that right now there is an additional surplus, but there was a very sizable surplus thanks to Powerball 71 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 and some of the other games, and all of that went to the budget balancing at a time that we got 0.8 percent increase over last year.
One of the issues that I hear here is the ability to reach out and provide information to seniors. Have you thought about, Celeste, using the City's website to provide information to seniors? We broadcast here. I don't know how it works, but putting on the website -- not the website.
PCN and/or the City, 63 or 64, information where seniors could go to access services?
I think you should. It's free and it's a way to get into the homes where senior citizens are watching TV. Maybe we could get the 72 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 major stations to run a byline, if you want information on senior services, turn to this channel or check your local channel or 64 City channel. This is a great site. I turn it on occasionally. There's information. Or there may be a City department presenting their budget or program to the Managing Director, which has been interesting to watch. So providing that information -- using that site could be helpful, because a lot of people -- it's just amazing. Because we do this every day, this is what we do, we assume people know. But a lady in church said to me on Sunday, I need to come talk to you, it's personal. Well, tell me what it's about. I need some help with my house, you know. So I told her what to do. And I said to myself, now she's just one of thousands who all the sudden -- never pay attention, because they don't have any 73 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 problems with their house. All the sudden you have a problem with your house. Well, what do I do about it.
So that might be a place for you to go. Any other questions? Councilwoman Brown. And then we're going to go to the next panel. The first panel always gets all the questions.
I wanted to underscore Chairwoman Tasco's recommendation. It's cost free. It is in the business of providing information about City services. And in terms of coordination and connecting the dots for seniors, to the extent that Philadelphia Corporation of Aging can send out regular 74 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 bulletin notes that this is available, it just broadens the reach of the awareness of the information. To Councilman Jones' concern, you say that you track seniors living alone. Did I hear that correctly?
That you track seniors that are living alone or that you maintain some kind of database.
No. No, we don't. I mean, the information that we have on seniors living alone is from the census, is from other telephone surveys and so forth. So we don't necessarily know who those people are that aren't currently known to the service system. That's always one of the challenges with any service system, is to identify people that may not be known to the service system, which is one of the reasons that we've been trying to reach out more to block captains, to clergy and others, both so they can provide 75 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 information but also so they can act as gatekeepers and kind of refer people that need help to the aging network. Because there are many people that sort of nobody knows about but may have significant needs.
And for those that you do know about, to what extent is that shared with anybody else in the universe?
For those that you do know about, to what extent is that shared with anyone else in the universe? To what extent is that information shared across systems, like the City's Office of Aging or PHDC, which maintains a database of seniors that need weatherization type of concerns?
Well, I think it depends in what context they're known. If they are one of our long-term care clients that are getting home care services, then we've done a detailed 76 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 assessment. We've completed referrals to all of the organizations that we think may be appropriate. If they're going to a senior center, then the senior center has done a job of gathering basic information and making sure that person is connected to services. So to a large extent, once somebody touches the aging network, there is an attempt to try to make sure that they are connected to whatever programs and services would be appropriate for them.
Two more final points. In the children and youth network, to the extent that there's no 18 violation of the, I believe it's, HIPAA, you can punch in a child's name and once the child's name comes up, it will tell you whether it's in foster care, whether it's been through the courts, whether it's a special needs child in the School District, so that there's some level of awareness across systems of what the 77 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 needs of that child are. And what I'm suggesting is that an opportunity exists for the aging community to work in a similar fashion, particularly when it comes to the central purpose of the resolution today. So that's food for thought. Finally to say that you receive dollars from the State, principally through the Lottery. Have you or do you customarily access dollars for weatherization of homes for seniors, since I hear that that's one of the number one needs of seniors who prefer to stay in their homes? Then again, in an effort to connect dots, we know that there are millions of dollars being released for this greening of the Commonwealth, and I know that a large portion of those dollars are being used for weatherization. So the question is, has PCA reached to or accessed those dollars that are being strictly used for weatherization for seniors who want to 78 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 stay in their homes?
We haven't. I mean, that's something we certainly can look at.
We've tried to work with other organizations. We also spent funds on home repair, but we haven't been spending any of our funds on weatherization.
I would offer that up as an enormous opportunity where those dollars either have been or are about to be released dealing with any and everything around sustainability and greening, and one of them is weatherization. Thank you for your testimony. Thank you, Madam Chairwoman.
Thank you very much. Any other questions? (No response.) 79 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735
Okay. We'll now go to the next panel. Diana Myers, Intra-Governmental Council on Long Term Care, Pennsylvania Department of the Aging; Lynn Iser, consultant and advocate for Creating Elder Communities. (Witnesses approached witness table.)
My name is Diana Myers, and with me is Lee Howard, my associate. We're going to attempt to use a PowerPoint, give you a chance to turn your heads a little bit instead of looking straight over here. I am a private consultant. My specialty is housing for special needs populations, including seniors, people with disabilities, the homeless, et cetera. I am not unfamiliar with Philadelphia, having been around Pennsylvania for almost 40 years working 80 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 in this field. One of the things that I've done -- and I don't know if you've seen this yet, but I did work on a 1997 report on housing needs of older adults for the City through the Office of Housing and Community Development. This is my only copy, but I'm sure you can get something from the Office of Housing if you don't have it. And there is some really good data in that there, some -- no. This is a different piece. This was an old study. It's 11 years old. It's maybe somewhat out of date. I've also worked with the Office of Housing and Community Development for over ten years on issues of people with physical disabilities in the City of Philadelphia. But I'm here today specifically with regard to the study done by the Intra-Governmental Council on Long Term Care. Paul McCarty, who is the Executive Director, was unable to make it today and he asked me, since I was the consultant 81 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 that facilitated the work group, if I would be able to come and make the presentation. So I'm going to try to make this brief. The report, you do have a full copy. That's what you just waved, Councilwoman Tasco. That is the full copy of the report. It's a 35report. It was done by people from 11 throughout the State from private and 12 public agencies and working over a year 13 on the topic. So I urge you to read the 14 full report if you want more details. 15 I'm just going to hit some of the 16 highlights today, and at the end of the 17 presentation, there's contact information 18 for both myself and Paul McCarty if you 19 want to follow up in any way. 20 So the purpose of the Housing 21 Alternatives Work Group, which we 22 affectionately call the HAWG, was to 23 identify and research non-traditional 24 housing options for the elderly and 25 adults with disabilities. So this report 82 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 covered also younger people with disabilities, not necessarily totally the population you're looking at. So some of the models and strategies also deal with that population. It was done. It started in fall of 2006. The Intra-Governmental Council on Long Term Care appointed the Housing Work Group with a goal to expand affordable, accessible housing choices using models that are not currently viable nor widely available in Pennsylvania. And the point here is that there are -- we were not addressing the need for additional resources for traditional housing options, like public housing, Section 8, subsidized housing, home modification programs, the things that you have already been relying on, but what they said is, let's try to maximize choices and try to find things that are non-traditional options that are not currently working for various reasons or not known about and try to give people 83 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 more choices. This is all part of the State's goal of trying to balance the long-term care system. You may be aware of the fact that presently the State's long-term care system, 80 percent of those dollars go into institutional settings, such as nursing homes, and percent into home 10 and community-based services. Their goal 11 is to balance that at 50/50 by the year 12 2020. So this Task Force's goal was to 13 help them look at home and 14 community-based options for housing that 15 would help meet that goal. 16 So they set up first a number 17 of selection criteria. There was about 18 12.
I'm just hitting on some of the most 19 key selection criteria that were used to 20 select the strategies and models that we looked at and in depth. And they were looking at, again, given the public and government situations, housing that would either have no cost or reasonable cost to the Commonwealth; solutions that would 84 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 have an impact to the greatest number of people or communities throughout the Commonwealth; solutions that would be affordable to the target population. And, again, in the housing affordability, the rule of thumb is that affordable housing is housing which people spend no more than 30 percent of their income towards housing costs. And that the options that we looked at be sustainable over the long term. So we came up with eight models or strategies. Now, again, they're a little bit apples and oranges. These are not all stand-alone housing models that you could develop and use. Some of them are things that you could use in existing housing; some are things that would stand alone. But I'm going to very briefly cover the eight models that we looked at. The first one is tenant-based rental assistance, which you all probably know as Section 8 or Housing Choice 85 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 vouchers, basically where an eligible family is given rental assistance in private housing. This is a wonderful model. It's flexible. It gives the maximum choice to people. And choice was a very, very critical part of this activity of the Task Force, because what we're saying is, again, some of these options might be attractive to three percent of the population or ten percent of the populations, but the idea was that people would have different choices, not just public housing or subsidized housing or the traditional choices, but the things that would be attractive to different people. Right now there is a pilot going on. The Pennsylvania Housing Finance Agency and the Department of Public Welfare are providing funds specifically for nursing home transition. This is for people who are moving from nursing homes back into the community, and that's a very major both federal and 86 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 State initiative at this point. And I believe the City of Philadelphia is due to get 101 tenant-based rental assistance vouchers from those resources to move people from nursing homes. And those monies are either currently available or they're coming down shortly. This money would be used as a bridge to permanent housing. So if a person is ready to come out of a nursing home but there are long waiting lists for Section 8 or Housing Choice vouchers, this would help them move out immediately, be on the Section 8 list. When their name comes up, that voucher would go back to help another person come out of a nursing home. So it's a bridge program. It's meant to be short term until longer-term assistance is available. The second is shared housing. There's two kinds of shared housing programs. Shared housing is basically when you have unrelated adults living 87 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 together. Those of you who are old enough to remember Maggie Kuhn, this was her idea, and she called it the family of choice, where people would actually live together but not necessarily be related. There's two shared housing models. One is a group-shared residence where five to ten people would live in a house together, making their household decisions, et cetera. And I'm going to talk about another model later that fits the group-shared residence model. But what I want to talk about now is a match-up program, and that's a program that is really good for a place like Philadelphia, because we have many older individuals who are living in homes by themselves that may be older homes. They do not want to move.
However, they may either have some difficulty keeping up the housing costs or they may need some physical assistance in remaining home, some help with shoveling the snow or picking up the leaves or purchasing the 88 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 groceries or taking out the trash or whatever. So a match-up program basically provides staff that would help a home provider, which is the person who owns the home, and have somebody else who comes in and lives with them called a home sharer. Generally the home sharer has a private bedroom and they share a common area such as the kitchen, living room, et cetera. It can be a service exchange. It does not have to be. Very often these are intergenerational. There will be an older adult who owns the home and a younger person can come in. Sometimes it's a student. Sometimes it could be a single-parent household. There are many different examples of this kind of match-up. The good thing about this program is, it is very inexpensive to administer compared to other housing programs, because there may be just one staff person, you can make a number of 89 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 matches. The thing to remember, however, is that it can be -- it's a fairly low-volume program in the beginning, because you have to build up a certain number of people in your pool until you make good matches, because the idea is that people are matched in terms of the characteristics that they want and the things that are important to them in their households. Next is clustered housing/clustered services. This is basically -- and this covers a realm of issues, such as service-enriched housing -- these are other terms that you may hear -- service-enriched housing, supportive housing, assisted housing, service-coordinated housing. But it could be for either existing housing or new housing that is linked to the services that an individual needs. So it's not done on an individual basis. It would be done on a larger volume basis so 90 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 that it could be more affordable. The key is, a lot of people do want to live in some sort of an assisted-living model where they have the services delivered to them in their home. Right now that costs about $3,500 a month for obtaining that service. So the critical piece here is how do we make that same option available for low- and moderate-income people who cannot afford $3,500 a month for their housing. So what's being done around the country is many different models of people matching up services. And I believe, for example, the Housing Authority in Philadelphia is bringing in types of services to some of its tenants, for example, but it could be bringing them to a NORC, Natural Occurring Retirement Community, where you would bundle services and bring them in. There's basically three service models of doing this. One is where you would actually provide on-site staff. Suppose you're looking at an existing 91 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 subsidized housing or an existing apartment building somewhere and the housing provider would bring in staff to provide those services needed. The second one would be to hook up people, link people, either through a service coordinator or some other method, to outside service providers, as needed. And the third one is to have services co-located in the housing, such as -- right now there's adult daycare centers are locating various meals programs, things like if you've heard of the PACE model or LIFE model that's being used in Philadelphia. They can be located in senior housing or near housing that keeps people where they are. The next one is housing facility design modification strategy. It's a very long term. It's basically where -- it's a strategy to make building modifications in order to make it easy and safer for individuals to age in place. So basically you're making 92 12/2/08 - PUBLIC HEALTH & HOUSING - RES.
080735 whatever changes, mostly physical changes. It could be adding a room for, again, meals, common areas, adding space for staff, dining facilities, et cetera, offices. The apartments, however, are generally still independent again. So this is for somebody who might be living in an independent apartment, for example. There's two models of this. One would be where there's currently people living in an apartment, either senior housing or their own apartment, and the developer or the owner decides they want to convert one floor that people are aging in place. I happen to be on the Board of Federation Housing, and we have a thousand units of housing in Northeast Philadelphia and these folks have been there 20, years, 20 for example, and they are starting to age 21 in place, and we're bringing in services 22 as possible, but it may well be that we 23 want to take a floor from one of those 24 buildings and make sure that that is more 25 like assisted living, so that people can 93 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 stay in their homes and receive the services that they need. The other one would be to take the other end, which is the nursing home, again, since we're trying to take nursing home beds offline -- and the State is doing a lot of different innovative things about trying to do that, by the way. But you want to take nursing home beds offline and make that into assisted living. That has more challenges because it's going to be harder to take something that's institutional and make it more home-like. So that would have to be done in just the right way, but it is also an alternative for converting facilities. There is a HUD-funded assisted-living conversion program. However -- and three projects in Philadelphia have been funded under that program over the years, but they have all had a very difficult time in making this work, because Pennsylvania did not have, until recently, an assisted living 94 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 licensing program. And so it either had to be as a personal care home or a nursing home, and it was very hard to fit in and meet the federal requirements of that program. So now that Pennsylvania has passed assisted living legislation, this might be a program to keep our eye on, because there are federal dollars that can go to some of the 202 projects, 236, some of the federally funded apartments where seniors are living that could be converted to assisted living.
Point of information. Is that for just conversions or new housing developments?
Conversions, this program. They still have the 202 and the 811 programs for new construction.
Limited equity housing co-op. This is one of my favorites. It's a little complicated, but it really is a wonderful model 95 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 because it provides an opportunity for people to maintain long-term affordability and control of their housing. And basically it's an ownership model in which there is a corporation that owns the building. And in the limited equity one, it's a non-profit corporation, and the shareholders are the residents of the building and they own shares in that corporation. It is a joint decision-making program. And, again, this is not for everybody, but it's one in which people are comfortable in making decisions about their housing with their neighbors. It allows a smooth succession of ownership, and the value of the -- unlike a regular co-op where the value like we have in Center City Philadelphia, William Penn House or some of those other places where the value of that share would increase with the market, the limited equity are kept affordable because there's subsidies in it, so that when a person leaves, 96 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 another low- and moderate-income person can move in that house. And I think there are maybe two or three of those operating in Philadelphia at the current time. But it really is a good model and, again, for long-term control and affordability. The residents are responsible for all the management decisions, and the co-ops that I'm familiar with range anywhere from the residents doing all of the work, including all the management and housekeeping and so forth and household rules, to their subcontracting all of those services out and everywhere in between. So some of them may contract out certain building maintenance and keep other functions. The sixth one is enhanced adult foster care, and, Councilman Jones, I think you were sort of walking around the edge of that. This particular one we looked at was from Massachusetts. It's similar to the Pennsylvania dom care 97 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 model where an individual would live in their home, they live with a family or another caretaker. The differences are that in Massachusetts the way it's run, some of the costs are reimbursed through Medicaid, which is really a big plus obviously. The care can be either in the consumer's home or in the caregiver's home. It's not always moving to somebody else's house to have to receive this care. You can stay in your house and have somebody move in and provide care to you. And -- the big one, which is what you are talking about, I think -- is, the caregiver can be a family member. In Pennsylvania currently under dom care that's not permitted. So this would be something that we might really want to look at in Harrisburg. And fourth, during, again, the dom care model, you're responsible 23 hours a day for somebody. Under this 24 model, there are respite programs available, adult daycare and things that 98 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 people would not have to be on site hours a day, which would probably be good for both the caregiver and the person provided for. The next one, building technology. This is building an assistive technology. These are technological things that help people to age in place, and there's some incredibly exciting thing going on, particularly in Philadelphia and in Allegheny County in Pennsylvania. I'm not going to speak too long, because I understand people from NewCourtland are here. They're going to speak about this. There is a group in Allegheny County called Blueroof Technology where they are using technology in manufactured housing, and they're putting in and they have four different levels of things, and these are wonderful things, like monitoring of the pantry. If you don't open your cabinets and then people can see that you're not opening your 99 12/2/08 - PUBLIC HEALTH & HOUSING - RES.
080735 cabinets, perhaps you're not eating, that they can really stem any possible health problems later on. And I believe NewCourtland has things or some of the medical monitoring where you get your blood pleasure and other things over the computer and somebody is keeping it somewhere for you. So they are remote monitoring of people's health and safety basically. Very exciting things. To me, this is really one of the things that I think can just make a dramatic difference in aging in place. The last one is the Abbeyfield Homes. This is -- we had to put in one foreign model. This is very popular in Britain, in England. They are small home-like settings. Remember when I talked about a group-shared residence of shared housing? That's really what this is. And the difference between a group home and shared housing is that shared housing is choice. People choose who they live with. They make their own 100 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 household policies, et cetera. They run the household. It's not some third party who is giving the key and doing whatever. This is somewhere in between, because they have an on-site housekeeper that serves two meals a day, et cetera. But, again, it's a good use of large renovated homes in residential areas. There can be zoning issues. However, a number of years ago we worked on a specific zoning model in Lower Merion Township, because Lower Merion at the time had a lot of students that were sharing and they wanted to kind of avoid that but they wanted to provide an opportunity for seniors, and we actually developed a specific zoning ordinance for seniors living together in group-shared residences.
That sounds familiar in my district. That sounds like a part of my district.
There you go. So that might be something to 101 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 consider. And there was a study done by Dartmouth on whether this was a good model to replicate in the United States, and they basically said be cautious, because it relies a great deal on volunteers and things, but I do believe in the right community this could be a good option. So that's the end of the State study on what we did. I took the prerogative, knowing since I've been around here a long time, to make some recommendations from me, Diana Myers only. This has nothing to do with the State. And my suggestions would be either to form a task force or -- it sounds like you already have some good task forces. You might want to just assign this to one of your existing task forces to review some of these models and determine what would be good in Philadelphia, which ones you could use. And the full report has a bunch of very specific recommendations for moving next 102 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 steps for each of the models. I would go with tenant-based rental assistance. Keep a close eye on the nursing home transition, see how that's working, and then maybe figure out how that model could be expanded to people who are living at home but are cost burdened, people who are paying 50 and 60 percent of their income for housing. Not people moving out of nursing homes, but people who are already living in the community and are facing economic hardship, but get some -- and usually those people, it's a small amount, it's not a large amount of money. It could be a matter of a hundred dollars a month to enable that person to stay in the community with the right rental assistance. Secondly, shared housing. I would consider -- and, again, Philadelphia had a shared housing match-up program in the '80s and '90s, and I think -- my personal opinion is 103 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 that there was many issues with it, but I think probably a lack of leadership really caused it to go under. But I think it was a good model. And, again, it's not for everybody, but given that it's low cost, I would consider maybe looking at that again. Montgomery County is about to start a pilot, and there's also existing programs right now in Chester County and Delaware County. So you could look at those. Two more suggestions on the housing facility design modification. Now that the State has passed assisted living legislation, I would take another look at that, see what's happening with the three projects in Philadelphia that were already funded and try to grab some more of that federal dollars to convert appropriate properties in Philadelphia. I would be careful, however, to limit the number of units to be modified if you're looking at an independent housing, because there's a psychological thing 104 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 here about, well, if 50 percent or 60 percent of the units are for frail people and assisted living, if I'm independent, I don't want to -- I may see it as a place for frail, elderly and not want to move in. You may impact the number of independent. So you would probably want to keep it to percent or something 10 like that of a facility. 11 And the building technology -- 12 again, I'm very enthusiastic about 13 that -- I would look at having the Office 14 of Housing and Community Development 15 provide some incentives to fund -- the 16 projects that they fund through Community 17 Development Block Grants and HOME dollars 18 and other federal dollars and State 19 dollars and City dollars for housing, 20 that they give some sort of incentive to 21 those projects to incorporate technology 22 in the appropriate projects. Because 23 we're all getting older. We're facing 24 the -- I think I'm right on the cusp of 25 the baby boomer, so I'm like my foot is 105 12/2/08 - PUBLIC HEALTH & HOUSING - RES. 080735 there already.
So I think we really ought to be preparing for the future, as Councilman Jones said. And here's some information for contacts.
Thank you very much. Very interesting. Any questions?