Affordable Assisted Living

1. Affordable Assisted Living Breaking New Ground in Iowa Presenter: Angela L. Adam, MHA Administrator, The Rose Senior Living Communities in Ames and Des Moines www.EverGreenREDC.com

3. Benefits Serving an underserved population Alternative housing options for tenants Family Burden/Stress on family and tenant Nursing Home Tenant may not require that level of care Alone Lack of socialization May benefit more in secure environment/24-hr staff on-site Low Income Housing May not have nursing staff on-site 24/hr Lack of planned activities/Care Plans

4. Benefits Ability to provide increased services as needed Rental Rates below Market Rent Rates Assets may last longer if currently residing in Market Rate Assisted Living at level 1 care. Ability to accept alternative forms of payment Medicaid for nursing/nurse aide services Waiver for meals, transportation, housekeeping and pendant Housing Choice Voucher and HCBS Rent Subsidy for Rental Assistance

5. Challenges

6. Public Education Often confused with Market Rate Assisted Living Facilities and Subsidized Housing Few have heard of or understand the concept of Affordable Assisted Living Communities

7. Marriage of Affordable Housing Regulations and Certified Assisted Living Regulations Affordable Housing Cannot require services/amenities be accepted unless included in the rent and/or charged to all tenants. Assisted Living Required to make available services and amenities such as Transportation, Meals, Nursing, Emergency Response

8. Creative Solutions

9. Creative Solutions Staffing Contracted Service Provider provides homemaking, nursing, and therapeutic staff Facility staffs maintenance, dietary, administrative and common area housekeeping staff

10. Creative Solutions Nursing Care Provided by contracted Service Provider Medicaid, Medicare, Private Insurance, and private pay to cover care provided. Apartment Housekeeping Provided by Service Provider Waiver, Private Insurance and Private Pay accepted

11. Creative Solutions Unscheduled Visits Care Call Plan Non-emergency and non-scheduled visit from a home health aide that does not exceed 15 minutes. Billable at $7 per visit.

12. Creative Solutions Activities Board Package Flat Rate e.g. $100/mo (Optional) Covers activities above and beyond regularly scheduled activities, supplies, and Activity Coordinator’s wages. Outings, shows, ceramics, etc. Covers PERS usage/availability Waiver recipients may have package for $65/mo because $35/mo is paid by the waiver for the PERS availability and usage

13. Trip to the Carousel

14. Party in Community Room

15. Creative Solutions Activities Fee for Service Activities beyond regularly scheduled activities can be purchased individually. Fee for activity will cover the bus fare, admission and man hours in coordination and implementation of activity

16. Creative Solutions Personal Emergency Response System Board Package Monthly fee covers availability and usage. Waiver monthly payments cover waiver recipients availability and usage. Non Board Package participants and non waiver recipients pay $40 each time the pendant is used. This covers the cost of availability and usage.

17. Creative Solutions Personal Emergency Response System Fee for Service Tenant may choose any provider (e.g. Lifeline, Healthwatch) or our internal system. If another provider is chosen, internal staff is the 1st on the call list. Tenant pays a monthly fee which covers usage and availability.

18. Creative Solutions Meals - Provided on-site Internal staff prepare/serve 2 meals/day Food Service Account managed separately from Operational Account Self-sustaining Separate Medicaid number obtained for waiver billing by Food Service Account

19. Creative Solutions

20. Rose apartments include fully-equipped kitchens

21. Creative Solutions Meals Other Alternatives Monday thru Friday – meals provided by neighboring Senior Center, Meals on Wheels or Mom’s Meals Weekends – Meals either transported from another facility or contracted through local restaurant operator If tenant interest in meal plans increase, internal meals may be prepared

22. Assisted Living Comparison Market Rate AL Levels of Care Unlimited income/assets Internal nursing and housekeeping staff Buy-in, community fee, or other initial fee. When assets are spent down, may need to find alternative placement Affordable AL Ala-Carte Services Maximum income limits Contracted services Initial deposit, nursing assess. fee and background check fee Assets may be spent down at a slower pace, then tenant may be eligible for financial assistance

23. Current Projects

24. Current Projects Emerson Point - Iowa City - 2003 Low Income Housing Tax Credit Program 54-One Bedroom Units Emergency Response System Lifeline Nutrition Program The Heritage Area Agency on Aging 2 Meals per day Service Provider Mercy Home Health Care

25. Current Projects Prime Living in LeMars – October 2004 Low Income Housing Tax Credit Program Created their own Home Health Agency Filling on a schedule that is typical for market rate programs

26. Current Projects The Rose of Ames – March, 2005 Low Income Housing Tax Credit Program 52 One-Bedroom Units, 4 Two-Bedroom Units Service Provider Lutheran Community Health Services Nutrition Program Internal Emergency Response System Internal

27. Current Projects Cedar Place in Story City 22 units Funded through HUD’s assisted living conversion grant program Services provided by Bethany Manor, a nursing home nearby

28. Current Projects Petersen Commons – Davenport, IA 50-units Low Income Housing Tax Credits Service Provider: Genesis Visiting Nurses Association

29. Current Projects Oneota Housing – Decorah, IA HUD conversion program Converting 16 low-income housing units to Affordable Assisted Living Certified April 2005 Services provided by Aase Haugen Homes, a long-term care provider in close proximity to the program

30. Current Projects Allamakee Housing – Waukon 16-units HUD conversion grant Service Provider: Veterans Memorial Hospital

31. Current Projects The Rose of Des Moines – Dec., 2005 Low Income Housing Tax Credit Program 48 One-Bedroom Units, 4 Two-Bedroom Units Service Provider Lutheran Community Health Services Nutrition Program Internal Emergency Response System Tenant’s Choice – Internal Option

32. Current Projects Walden Point 52-units Near Mercy Hospital in Des Moines Opened September, ‘06 Service Provider: Mercy Home Health Care Nutrition Program Mom’s Meals or Meals on Wheels

33. Our tenants’ experience at The Rose of Ames

34. Case Study: A Gross Annual Income: $7,212 + an asset of only $0.10 in a checking account at move-in On Medicaid and the Elder Waiver with nursing and nurse aide services covered under Medicaid. Meals, housekeeping, transportation and pendant covered under the Waiver. Also has HCBS Rent Subsidy. Pays only $180.30 out-of-pocket in a Certified Assisted Living facility, receiving all services available in a 714 sq. ft. one-BR apt. with a full-sized refrigerator, full-sized stove and oven, dishwasher, & garbage disposal.

35. Case Study: Tenant B Gross Annual Income: $13,497.69 + Less than $2,000 in assets at move-in Has Section 8- Housing Choice Voucher Pays only $315/mo rent, $35.95/mo PERS, and 2 meals per day ($12/day) Does not receive nursing or housekeeping services. Pays a total of $636.15/mo to live in a fully equipped, 748 sq. ft. Assisted Living Apartment with meals, pendant and activities.

36. Why we love our jobs!

37. Thank You To IFA for the invitation To you for your growing interest in AAL To the Iowa Finance Authority (especially Jenny Knust) for the information shared from the links on http://www.ifahome.com/affordable_assisted_living.asp

38. My Contact Information The Rose of Ames 1315 Coconino Rd Ames, Iowa 50014 (515) 268-8828 AngelaRoseOfAmes@qwest.net Rose of Des Moines 1330 19th St. Des Moines, IA 50314 Phone: (515) 244-3300 AngelaRoseOfDM@qwest.net

39. Affordable Assisted LivingProgram Information Jenny Knust Affordable AL Program Iowa Finance Authority Jenny.knust@iowa.gov