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Miami Housing Agency Brings Assisted Living to Frail Elderly |
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In Miami, 99 public housing residents, mostly women in their 80s, can remain in their own apartments and with their own friends, even as they become more frail. The new Helen Sawyer Plaza Assisted Living Facility includes a continuum of services such as cafeteria meals, assistance with medications, and help with bathing and grooming. Offering great flexibility and a broad range of services, assisted living has become a popular option for elderly people who need some help carrying out the basic tasks of daily living but are not frail enough to make a restrictive nursing home placement appropriate. With the opening of Helen Sawyer Plaza in 1999, the Miami-Dade Housing Authority (MDHA) became the first housing authority in the nation to offer assisted living for elderly public housing residents. MDHA, the sixth-largest housing authority in the country with more than 5,000 elderly clients, had to overcome a morass of licensing and funding barriers to open Helen Sawyer Plaza. The agency converted an underutilized independent living facility into a multiservice center that provides various levels of assistance, depending on a senior's particular needs. It is appropriate that Florida would develop the first public housing assisted living facility. Florida leads the nation in proportion of elderly residents, with 18 percent of its residents over the age of 65. The elderly population is expected to double in the next 50 years. Not all of Miami's elderly are comfortable Sunbelt retirees. Many have few financial resources, no family members to draw on, are in poor health, and have limited housing options. "What our population looks like now is what the population of all states will look like a few years from now," says MDHA Director Rene Rodriguez. "Our program is important because it shows other housing authorities that they can give low-income seniors a quality of life only thought possible for higher income individuals." The facility has renovated efficiency and 1-bedroom apartments with air conditioning and balconies. The apartments have light cooking facilities and individual emergency alarm systems. A full kitchen with a residents' dining area, a community room, administrative offices, a maintenance staff area, a lobby, and public restrooms are located on the ground floor. The property has an electronic entry system and 24-hour security guards. Converting to assisted living. From its beginnings in 1976, Helen Sawyer Plaza provided elderly public housing and for years offered group meals. But by the mid-1990s, it no longer provided congregate meal service, creating a significant hardship for residents who had only minimal amenities in their rooms. This situation combined with poor transportation services and a dangerous surrounding neighborhood to make it an undesirable place to live. By 1995 the building was only 30-percent occupied. Concerned about the facility's future, MDHA contracted with MIA Consulting Services for a utilization study in 1996. MIA found that because the facility offered few services, residents had to move to nursing homes when their health began to deteriorate. This approach to eldercare, says Rodriguez, was "totally contrary to where we were headed, which was to help seniors age in place in the least restrictive environments." MIA recommended converting the building into an assisted living center by getting all of the licenses, services, and funding required for onsite activities such as meals, therapy, nursing services, and adult daycare. In 1998 MDHA approved the ambitious plan. Since the physical structure of the facility was sound, rehabilitating the building was a fairly straightforward job, says Rodriguez. The challenging part was putting the services into place. MDHA opted for an approach called vertical integration—providing multiple levels of service so that seniors with different needs, ages, and degrees of frailty could live in the same facility. "What you see at Helen Sawyer," says Rodriguez, "are some seniors who just need housing; some who need their meals provided but can take care of all their other basic needs; some who require medication management; and still others who need to be bathed, groomed, and fed." Previously, elderly married couples had to split up when one partner could no longer care for the other. Elderly couples now can continue to live together in Helen Sawyer Plaza, even to the end of their lives. The first step in the conversion was receiving an assisted living facility license from the state. Florida highly regulates the assisted living industry, imposing many standards and requirements on the housing environments and the services offered. "It is very difficult to meet all these requirements," says Rodriguez, "and then you also have to comply with local building regulations. Not surprisingly, sometimes all the layers of government weren't in unison and we had to find creative solutions." In addition, MDHA worked closely with Miami and Dade County to clean up abandoned buildings in the area and expand transportation accessibility. New rail service now makes it easier to travel to downtown Miami (just 5 minutes away), and an onsite bus ensures residents can get to nearby doctors and shopping. Tapping into Medicaid funding. The service-rich facility is made possible by linking low-income housing subsidies with Medicaid funding. Almost all elderly public housing residents are eligible for Medicaid funding. In 1998 MDHA asked the State of Florida Department of Elder Affairs to grant a waiver making Helen Sawyer's assisted living services eligible for Medicaid funding reimbursement. (Until this point, state Medicaid funds had covered only long-term care for the frail elderly in nursing homes.) Later that year, Florida's state legislature allocated $1.3 million in Medicaid funding to MDHA for elderly services provided at the Helen Sawyer Plaza Assisted Living Facility. Now HUD funds cover senior housing expenses and Medicaid funds pay for the meals; transportation; and medical, laundry, and other services provided to residents. MIA was instrumental in achieving the Medicaid waivers. One of the firm's principals is a former assistant secretary of the state's Department of Elder Affairs, and "she knew all the ins and outs of possible funding sources," says Rodriguez. MDHA retains ownership and operational control of Helen Sawyer Plaza, while MIA provides day-to-day management of the facility and hands-on care for the residents. "MDHA ensures quality control by having our own case manager on site who reports to us and assesses what services are needed for each resident," says Rodriguez. Altogether, there are 12 full-time staff and 2 part-time social workers. MDHA is building a second continuum of care center for seniors called the Ward Towers Assisted Living Facility through a $4.7 million HOPE VI public housing revitalization grant. Ward Towers will be a 5-story, 95-unit apartment building joined to an existing elderly housing complex by a 1-story service center. It will provide a range of services including health care, meals, and transportation, as well as an Alzheimer's wing. Rodriguez is convinced that other housing authorities should give strong consideration to this approach. "It not only gives seniors peace of mind, but it saves local governments money," he says. Preliminary MDHA research suggests that Helen Sawyer's per capita long-term care costs may be as little as one-fourth of those of a nursing home. For more information, contact: Rene Rodriguez, Director, Miami-Dade Housing Authority, 1401 Northwest Seventh Street, Miami, FL 33125, (305) 644-5112. Or see: HUD Best Practices 2000 "Local" Awards, and Helen Sawyer Plaza—A New Concept in Public Housing, by Rene Rodriguez, Director of Miami-Dade Housing Authority.
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