LeadingAge New York Adviser Adviser LeadingAge NewYork Spring 2019 final | Page 18

Does Affordable Assisted Living Exist?
There is great variation across the country in both the definition of assisted living and how an “affordable” or
low-income option is made available. Most states use federal waivers to provide Medicaid-covered services in
assisted living, which often have caps or limitations on total enrollment. Most offer personal care and supports,
and some include varying degrees of nursing and support. To be eligible for such services, people typically must
be at a nursing home level of care. Many states use Supplemental Security Income (SSI) to help offset room and
board costs; however, like in New York, the rates tend to be very low.
In the Wednesday session Does Affordable Assisted Living Exist?, speaker Andy Edeburn, principal, Premier
Performance Partners, provided some startling statistics that highlight the growing need for affordable
assisted living:
The number of middle-income elders will nearly double by 2029 – from 7.9 million to 14.4
.
million – and will make up the biggest share of seniors, at 43 percent.
By 2028, more than half of middle-income Americans age 75 or older will not be
.
able to afford to pay for yearly assisted living or medical expenses, with annual
financial resources at $60,000.
Adult children of seniors are contributing a great deal to their loved ones’
.
care, and we have quantified that cost.
While the need for more affordable models of assisted living is clear, no one answer or
state model emerged as ‘the solution.’ Edeburn emphasized the need for greater in-home
supports, co-housing and Medicare Advantage supports to foster services in the community. The
residential component of assisted living is a huge cost driver, and thus providing ‘assisted living-like’
services in the community can be more affordable. Of course, some segment of the population needs
more supports and supervision that can be managed in the community, workforce is a significant challenge
and there is a lack of affordable housing in New York City. Certainly, technology that can support independence
is evolving, and the general public is becoming more comfortable using it.
Session participants noted that New York’s current models of assisted living drive overutilization of acute care,
and the layers of regulation add complexity, confusion and cost. In looking for solutions to the affordability
issue, the concept of a third payer for Medicare/Medicaid-type services to keep people in the home or
assisted living was discussed as a future policy concept to explore. This is a critical conversation for
LeadingAge New York to continue, to ensure that we will be able to meet the future needs of New
York’s aging population.
Selfhelp Active Services for
Aging Model (SHASAM)
At this engaging session, Selfhelp Community Services presented on the best practices of
providing a true aging in place model within their communities. Much of their focus was on the
integration of the formerly homeless community into their housing through the use of the Senior
Affordable Rental Apartments (SARA) Program, which requires a set-aside of 30 percent of the units for
formerly homeless seniors, and Empire State Supportive Housing Initiative (ESSHI) grants, which provide a
stipend of $25,000/unit for services and operating funds within the community. Their presentation made clear
that while there may be challenges to bringing services to seniors’ homes, and particularly to get these services
to formerly homeless seniors, with the right approach and tools, it can be done successfully.
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Adviser a publication of LeadingAge New York | Spring 2019