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Occasional LTC Policy Paper Series
Duke Long Term Care Resources Program Paper No.12

Jocelyn Fina, Contributing Author
Ann B. Johnson, Guest Editor

Table of Contents:
About the Authors

Governor's Advisory Council Selects Housing as Issue
Highlights: Governor's Advisory Council's Housing Forum
Afternoon Session: Local Initiatives
Recommendations on Housing: Governor's Advisory Council on Aging

From the Editors:

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 Advisory Council.


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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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 needs:

  • 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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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 to attend.

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.


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 Care Commission:

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:

  1. Convening the Department’s Housing Work Group to connect the housing and human service systems;

  2. 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 States; and

  3. 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 attention included:

  • 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 of ramps.
  • 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.

Mark You Calendars
Annual Maddox Lecture
Richard Schulz, PhD
March 23, 2004
For more information: www.geri.duke.edu

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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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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 time.

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 in:

  • 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 Olmstead Plan.
  • Re-instating the preference for the homeless and persons with disabilities in local Housing Authority Administrative plans.

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 with disabilities.

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 North Carolina.

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 Persons

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.

To Learn More about Aging and Long Term Care
in North Carolina

go to:

North Carolina Division of Aging: www.dhhs.state.nc.us/aging
North Carolina Long Term Care: www.dhhs.state.nc.us/ltc

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