Occasional LTC Policy Paper Series
Duke Long Term Care Resources Program Paper No.12
HOUSING FOR OLDER ADULTS IN NORTH CAROLINA:
MORE THAN SHELTER
Jocelyn Fina, Contributing Author
Table of Contents:
Ann B. Johnson, Guest Editor
About the Authors
Governor's Advisory Council Selects Housing as
Highlights: Governor's Advisory Council's Housing
Afternoon Session: Local Initiatives
Recommendations on Housing: Governor's Advisory
Council on Aging
Since its inception in 1988, the Duke Long Term Care Resources
Program has included housing as a key component of comprehensive,
responsive long term care policy. As a part of Duke LTC’s
continuing interest in housing policy, this paper reports
on the recent housing policy work of the Governor’s
Advisory Council on Aging in North Carolina as a part of Duke
LTC’s Occasional LTC Policy Paper Series. When
selecting the title for this policy paper, Ann Johnson, Chair
of the Council and guest editor for this paper, emphasized
that the Council was interested in the issue of housing as
“more than shelter” to encompass the “physical
and emotional” support issues related to living arrangements.
This paper is divided into two parts: Part one summarizes
the work of the Housing Committee of the Council which was
chaired by Rev. Philip Brown, Vice-Chair of the Council. In
addition to holding several committee meetings, the Council
also held a public forum on housing for older adults in April
of 2003. The proceedings of the forum, which was chaired by
Rev. Brown, are a cornerstone of the work of the committee.
Part two presents the text of the recommendations of the Governor’s
About the Authors:
We are also pleased to note the involvement of a Duke Leadership
in an Aging Society Program Intern, Jocelyn Fina, in the work
of the Council and the preparation of this policy paper. As
an intern placed with the North Carolina Division of Aging,
Ms. Fina attended the housing forum in April as a reporter
and subsequently prepared a summary of the proceedings from
which this paper has drawn. Ms. Fina is a Phi Beta Kappa UNC-CH
Senior majoring in Health Policy and Administration at the
School of Public Health. She plans to pursue a career in health
law. To learn more about the interdisciplinary, interinstitutional
internship program, go to www.ltc.duke.edu.
In closing we also would like to thank Mary Bethel and Jodi
Hernandez of the North Carolina Division of Aging for their
help in the development of this paper. To learn more about
housing for older adults in North Carolina; to view the summary
of the housing forum in its entirety and to access the NC
State Aging Plan go to www.dhhs.state.nc.us/aging
George L. Maddox, Editor
Sandra Crawford Leak, Associate Editor
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GOVERNOR’S ADVISORY COUNCIL
SELECTS HOUSING AS ISSUE
This Occasional Policy Paper features
the recent work of North Carolina’s Governor’s
Advisory Council on Aging to address the housing needs of
older adults. The Governor’s Advisory Council is the
body created by North Carolina state statute in 1971 to
make recommendations for state policy and legislative action
to the governor and the secretary of the Department of Health
and Human Services. Ann B. Johnson, Chair of the Council,
emphasized the comprehensiveness of housing as an issue:
“Housing for older adults should include living
arrangements which go beyond the bricks and mortar of shelter
and include both physical and emotional supports.”
The Council’s selection of housing as an issue also
reflects the influence of the Americans with Disabilities
Act of 1990 and the United States Supreme Court decision
in the Olmstead case which requires each state to develop
a plan consistent with the desires of persons with disabilities
to remain in the community rather than in institutional
settings. A Housing Committee of the Governor’s Advisory
Council, chaired by Reverend Philip Brown, Vice Chair of
the Council, met three times over 18 months to gather information
and plan for a one day forum on the topic. This paper summarizes
the proceedings of the forum and presents the recommendations
that resulted from the Council’s deliberations.
About Housing: From the North Carolina State Aging Plan
The North Carolina State Aging Services
Plan for 2003 – 2007 includes “shelter”
in its array of essential requirements for all older adults
and emphasizes the need for seniors to “live in adequate
housing.” The plan reviews the current state of housing
for the elderly. It notes that while advocates have emphasized
the importance of safe, affordable and accessible housing
for older adults and achieved some success as illustrated
by an increase in the Homestead Property Tax Exemption for
low-income older adults, there are still striking gaps and
5,000 homeowners and renters over
age 65 lack complete plumbing facilities in their homes.
(US Census Bureau)
53% of renters over age 65, or almost
48,000 older North Carolinians, spend more than 30% of
their income on rent. (US Census Bureau)
The largest increase among the homeless
population between 2001and 2002 in North Carolina was
among those 55 and over. (NC OEO)
Only 101 housing units could be approved
in 2002 under the tax-credit program administered by the
North Carolina Housing Finance Agency (NCHFA).
Support for the Housing Trust Fund
has been reduced from $8 million in 2000 to $3 million
in 2001 and $2.7 million in 2002.
Such cuts have been occurring at time
when natural disasters, particularly hurricanes, have
aggravated the shortage of affordable housing.
While North Carolina also has Section
8 vouchers, aging advocates are concerned that these are
inadequate for the housing needs of many older adults.
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ADVISORY COUNCIL’S HOUSING FORUM
The Governor’s Advisory Council
held its Housing Forum on April 2, 2003. Reverend Philip
Brown, Vice-Chair of the Council and Chair of the Housing
Committee, moderated the forum. The purpose of the forum
was to clarify issues and trends and make recommendations
to address the future needs of older adults related to housing.
Rev. Brown noted, “It has been very difficult to get
a handle on housing needs of older adults in North Carolina.”
Funds from Carol Woods, a continuing care retirement community,
made it possible to include representatives of the faith
community and others interested in housing for older adults
In her opening remarks for the forum, Lt.
Governor Beverly Perdue called attention to the large increase
in homelessness in the older age group and the importance
of choices of affordable housing and services.
MORNING SESSION: NATIONAL AND STATE
The morning session of the forum focused
on national and state resources for elderly housing and
featured representatives from the state and federal government
as well as a university-based think tank and the NC Medical
Julia Bick, representative for the
North Carolina Department of Health and Human Services,
reported on three developments within the Department
during the past year. In addition to the creation of her
position as housing coordinator in the Office of Long Term
Care, the developments are:
Convening the Department’s Housing
Work Group to connect the housing and human service systems;
Expanding the Department’s
partnership with the Housing Finance Agency with respect
to the Low Income Tax Credit Program, which is
the largest source of affordable housing in the United
Addressing the issue of homelessness
through revitalizing the Interagency Council for Coordinating
Homeless Programs and sponsoring a policy academy on homelessness.
Ms. Bick’s suggestions for items that needed
Changing the “not in my backyard”
syndrome attitude among the public with respect to placement
of affordable housing.
Development of rental assistance for extremely
low income persons.
Be mindful of a movement to change NC’s
Building Code to an International one that has far less
stringent accessibility requirements.
The proposed building code change
was addressed further by Leslie Young from the Center for
Universal Design. At the time of the forum there
was a bill pending before the NC General Assembly that would
have a potentially negative effect on housing for older
adults through loss of future accessible housing; prohibition
of future state code amendments to improve accessibility;
and compliance confusion that could slow down the design
and inspection process.
The North Carolina Housing Trust
Fund was reviewed by Steve Culnon, Director of Rental Investments
with the North Carolina Housing Finance Agency.
The Trust Fund is used to assist in the development of affordable
rental units and for home repairs for local income households.
About 140 projects have been proposed for financing for
2003, however, without additional support for the Trust
Fund, only 40 can be funded.
Brenda Ward of US Department of Housing
and Urban Development reported on the Section 202 Program
which provides housing and supportive services to the elderly
as well as rental assistance. She indicated that
the Program was seeking non-profit sponsors and that interested
groups should call (336) 547- 4069.
Rural development funding provided
through grants and loans was described by Bill Hobbs from
the US Department of Agriculture. Funding sources
through USDA include:
504 funds for homeowners may be used for
indoor plumbing, electricity and installation
502 funds provide 100% financing
to build a new home.
515 funds through the multi-family
program can provide loans and grants for adaptations such
as handrails, call buttons and wheelchair accessibility.
It also has a rental assistance section.
Lucy Bode, Chair of the North Carolina
Medical Care Commission, discussed the affordability of
Continuing Care Retirement Communities for low and moderate
income seniors. The Medical Care Commission has
approved the issuance of over one billion dollars in bonds
to help finance CCRC’s in North Carolina. She discussed
the need for CCRC’s to be available to all older adults.
The Commission proposes to continue:
Working with communities to provide scholarships
and aid and improve diversity among residents;
Creating innovative ways to provide financial
options for people at all economic levels;
Creating awareness of CCR’s need
to reach out to all older adults; and
Encouraging partnerships with other organizations
to provide innovative efforts to provide funding and offer
affordable housing options.
Annual Maddox Lecture
Richard Schulz, PhD
March 23, 2004
For more information: www.geri.duke.edu
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AFTERNOON SESSION: LOCAL INITATIVES
The afternoon session of the Forum was devoted
to Local Initiatives:
Shared Group Residences (SGR’s)
was discussed by Cynthia Davis from the Mid-East Development
Corporation which was created by the Mid-East Commission
Area Agency on Aging in 1991 and has developed SGR’s.
Residents of SGR’s live in a home style setting sharing
common areas yet maintaining private living in bedrooms
and bathrooms. Ms. Davis cited the advantages of
SGR’s including security, affordability, supportive
services, modern conveniences, accessibility, privacy and
family style setting. Some of the advantages are
also key issues for SRG development. She indicated that
key issues include location, affordability, supportive services,
collaborative partnerships and community involvement.
The collaborative efforts of North
Carolina State University’s Center for Universal Design
to develop and promote accessible and universal design in
housing for older adults in North Carolina, was described
by Sally Haile. The Center has four main interests: research,
design, training and outreach. Examples of programs
with which the Center collaborates include Habitat for Humanity,
Lowes Home Improvement Training and Certified Agency and
Place Specialist Training.
Aging in place and naturally occurring
retirement communities was the topic of Jack Chestnut’s
presentation. He is the Community Liaison Officer at Carol
Woods Retirement Community in Chapel Hill, NC.
He discussed the need for local communities to plan
ahead for the type of support and services that will be
needed for the increasing older population to age in place
He called attention to naturally occurring retirement communities
(NORC’s) as a phenomenon which helps people
to achieve that objection.
Amanda Abrams, Policy Director for
the North Carolina Low Income Housing Coalition discussed
manufactured housing as a viable option for low income aging
persons. She noted that manufactured housing is
inexpensive and gives the resident a sense of ownership.
She identified some drawbacks such as manufactured housing
being classified as a vehicle rather than real estate in
terms of property type; price information not being standardized
to potential buyers; and an overall lack of consumer protections.
A Consumer Guide to Manufactured Housing is available
from the NC Low Income Housing Coalition.
The final presentation of the day
was on public housing by Allison Hapgood on the staff of
the Raleigh Housing Authority. She reported the experience
in Raleigh with public housing for the elderly.
The average age in the two highrises for older adults in
Raleigh has dropped from 62 to 50. Residents do not wish
to live above the fifth floor. The Housing Authority has
used creative measures to increase marketability including
improving aesthetic features, increasing community services
and improving safety.
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RECOMMENDATIONS ON HOUSING
GOVERNOR’S ADVISORY COUNCIL ON AGING
The following recommendations on housing
were developed by the Governor’s Advisory Council
as a result of its deliberations. The Council will track
progress in the implementation of the recommendations over
RECOMMENDATION # 1:
Addressing Fragmentation and Expanding Collaboration
The Governor’s Advisory Council on Aging
applauds ongoing efforts to address fragmentation and to
work collaboratively across agencies to address the housing
needs of low-income older adults and persons with disabilities.
The Council recommends that the Department
of Health and Human Services continue and expand upon these
efforts through the creation of either an Office or Division
of Housing within the Department of Health and Human Services.
This recommendation specifies that activities
of this Office/Division should include:
A. Assuring the involvement of consumers in
decision making (i.e. be included as members of advisory
committees to housing efforts within state and local government
and Area Agencies on Aging).
B. Facilitating the linkage of housing and
supportive services in housing developments for older adults
or persons with disabilities, including Naturally Occurring
Retirement Communities (NORC’s), to support individuals
to age in place and live successfully in the community.
C. Seeking cooperation among appropriate agencies
to increase the pool of housing affordable to extremely
low-income older adults and persons with disabilities.
D. Working with housing providers, including
Public Housing Authorities and Section 8 administering agencies
The examination of the regulations and
policies for older adults and persons with disabilities
to determine the extent of uniformity, compliance with
Fair Housing Laws, and concordance with North Carolina’s
Re-instating the preference for the homeless
and persons with disabilities in local Housing Authority
E. Collaborating with the mortgage industry
in bringing home ownership products into North Carolina
that are useful to older adults and persons with disabilities.
F. Developing an information and communications
plan to reach older persons and persons with disabilities
with information about housing opportunities, including
providing county specific housing availability information
to the Information, Referral and Assistance programs.
G. Maintaining an inventory of housing activity
in the state, including existing programs for targeted populations.
In addition, the inventory should include current funding
sources for new construction, rehabilitation, modifications,
and rental assistance.
RECOMMENDATION #2: Increasing
Targeted Funding and Coordination of Funding Sources
There is a need for increased targeted funding
and coordination of funding sources to better address the
housing needs of extremely low-income older adults and persons
The Governor’s Advisory Council on Aging
recommends the following :
A. That the General Assembly appropriate $25
million annually to the North Carolina Housing Trust Fund
which is the only source of state housing funding that addresses
the full range of housing needs currently facing North Carolina
families. The Trust Fund’s investment expands housing
opportunities and also creates jobs, builds the tax base,
leverages private investment and rebuilds communities throughout
Of the $25 million requested, the Council
recommends that $3 million of this amount be targeted specifically
for the Urgent Repair Program and for assisting low-income
property owners with installation of plumbing and running
water in homes currently without indoor plumbing. The Council
further recommends that the North Carolina Housing Finance
Agency seek linkages with other funders to insure that this
funding maintains the flexibility necessary to fill funding
gaps and maximize other resources.
B. That a state funded housing operating subsidy
program tied to existing housing production activities be
made available to increase the supply of housing to extremely
low-income older adults and person with disabilities. A
housing operating subsidy tied to an existing production
program is a cost effective strategy to underwrite the operating
costs of housing units so that rents can be affordable to
people with extremely low incomes. This program should be
administered by the North Carolina Housing Finance Agency
in collaboration with the North Carolina Department of Health
and Human Services.
C. Maximizing the allocation of any remaining
Hurricane Floyd Flood Relief Funds for low-income families
– particularly renters.
D. That $500,000 in state funds be appropriated
to establish an independent service coordinator grant program
for non-HUD eligible properties serving low and moderate
income residents to assist them in obtaining the information
and assistance they need to continue living independently.
E. That federal, state and local funding agencies
coordinate to maximize the availability of home improvement
services for older and disabled adults.
RECOMMENDATION #3: Development
of Continuing Care Retirement Communities (CCRCs) for Low-Income
There are no Continuing Care Retirement Communities
in North Carolina for low-income persons at this time.
The Governor’s Advisory Council on Aging
recommends that the North Carolina Department of Health
and Human Services, the North Carolina Department of Insurance,
the North Carolina Medical Care Commission, the North Carolina
Housing Finance Agency, faith based organizations, and aging
advocacy groups collaborate on a study to determine the
feasibility of developing Continuing Care Retirement Communities
for low-income persons.
RECOMMENDATION #4: Consumer
Protections for Persons Living in Manufactured Housing
Manufactured housing is a very popular housing
option in North Carolina. Nearly one in six North Carolinians
lives in a manufactured home. In many rural counties, this
increases to one in four persons. For low and moderate income
North Carolinians, manufactured homes often serve as a way
to provide an aging/disabled parent with independent living
quarters (“granny flat”) that are only steps
away from their adult children or other caregivers. The
North Carolina General Assembly in the 2003 legislative
session passed HB 1006 which grants greater consumer protections
to residents of manufactured housing. However, additional
safeguards are needed for persons who make manufactured
housing their home.
The Governor’s Advisory Council on Aging
recommends that additional legislation be passed to further
strengthen consumer protections for individuals purchasing
or living in manufactured housing.
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