Throughout the course of the pandemic, federal, state and local governments have been instituting eviction moratoriums to stop people from becoming homeless. While I commend these efforts, what about the people who are already homeless? At B’nai B’rith we sponsor senior housing, so naturally I’m curious about how prevalent homeless seniors are across the country.
The Annual Homelessness Assessment Report (AHAR) shows there are over 170,000 older adults (55+) who are homeless. These numbers are only expected to increase to 225,000 by 2026. Obviously, no one wants to see anyone homeless, and we want everyone to live in secure and safe housing. However, the problems associated with homelessness shouldn’t be examined as just putting a roof over someone’s head, but how appropriately health care and housing are intertwined.
The Homelessness Policy Research Institute reports homeless older adults are more likely to have health issues compared to older adults with housing. Research demonstrates ailments associated with seniors like frailty, cognitive impairment, urinary incontinence and vision impairment are higher in homeless older adults compared to people 20 years older with housing. Complicating matters, too many homeless seniors are not even aware they are eligible for Medicare and Medicaid benefits. According to the 2018 Greater Los Angeles Homeless Count, only 10 percent of homeless adults in Los Angeles receive Medicare benefits. Think about all the undiagnosed ailments and health care problems plaguing seniors that could be treated from the outset. Furthermore, it’s generally cheaper to treat medical problems if they are diagnosed early.
So, what does this all mean?
The University of Pennsylvania published a report, “The Emerging Crisis of Aged Homelessness: Could Housing Solutions Be Funded by Avoidance of Excess Shelter, Hospital and Nursing Home Costs?” that tackles these very questions. The study concluded that investments in housing for older adults could save money by decreasing health care, nursing home and shelter costs. The report states:
“However, that large sums of public funding will go toward this crisis whether we act or not should motivate us to find the best and most responsible use of those funds. We can spend those dollars on potentially unnecessary hospital and nursing home days, or we can improve the quality of life of these vulnerable citizens, reduce the daily demands on hospitals and emergency departments to care for them, and relieve shelters of the burden for large-scale, aging-related care for which they are ill-suited.”
Furthermore, the study demonstrated that investments in a comprehensive housing strategy in New York and Los Angeles could save millions of dollars in services and produce positive investments.
The good news is that elected officials have begun to act. Last year, Minnesota created a program called “Housing Stabilization Services,” funded through Medicaid to help people find housing, negotiate leases and stave off evictions by identifying issues before they become too problematic. The goal for the program is to reach 7,000 people during the first three years. While this program is a good start, the Medicaid benefits don’t pay for rent.
Working at B’nai B’rith has made me very aware of the supply of affordable housing versus the demand in this country. While we regularly advocate to Congress for additional funding, our work doesn’t stop there. Our annual Housing Conference and Managers and Service Coordinators Meeting has provided training and panel discussions on welcoming new members to our housing community who previously were homeless. This came about because we recognized that the elderly homeless are at even more risk due to fragile health, etc. and wanted to make sure that we are reaching out to a very vulnerable population that can benefit from living in Housing and Urban Development (HUD) assisted housing with service coordination available to them. Whether it’s dispelling stereotypes or connecting people with supportive services, we want everyone to feel welcomed and succeed in their new surroundings.
For example, Goldberg B’nai B’rith Towers in Houston and Pasadena Interfaith Manor have implemented the HUD homeless preference program that allows people without a home to more easily find a place to live. The staff at the buildings have treated these residents equally and the partnership with HUD has worked nicely. Also, caseworkers help prospective residents fill out paperwork, move into the apartments and assist with other daily activities associated with being a renter.
The Joint Center for Housing Studies at Harvard University reports that by 2038, 2.4 million more seniors who are considered very low income won’t have access to affordable housing. Numbers don’t lie. Senior homelessness is only going to become a bigger problem. This means money is being spent on services alone when housing is a more dignified and cheaper response. It’s time to take a more wholistic approach to providing services for people and see that issues like homelessness and health care are connected.
This is an exciting year for the Center for Senior Services (CSS), celebrating our 50th anniversary! B’nai B’rith sponsors Department of Housing and Urban Development (HUD) affordable housing across the country and currently our network comprises 38 buildings and serves about 5,000 people, making us the largest national Jewish sponsor of subsidized housing in the United States. B’nai B’rith’s housing footprint is across the country with buildings from New York to California, down to Florida and everywhere in between. We began providing HUD-assisted senior housing in 1971, when we opened our first sponsored building B’nai B’rith Apartments in Wilkes-Barre, Pennsylvania.
Not bad for fifty years!
Our housing network isn’t just about ribbon cutting ceremonies; it’s so much more. Mark D. Olshan, associate executive vice president of B'nai B'rith International and director of the B’nai B’rith International Center for Senior Services, was responsible for expanding our annual Conference on Senior Housing and starting our onsite staff training for management professionals. These trainings are a great opportunity for the B’nai B’rith housing community to come together, network with each other, and hear from experts in the field on how to make our individual buildings the best they can be for our residents.
Mark is also responsible for starting the bi-annual Resident Leadership Retreat, operating since 1987. This retreat not only connects fellow resident leaders throughout the B’nai B’rith housing network but provides many tools to strengthen their communities back home. Residents participate in intensive, day-long workshops regarding resident councils and by-laws, address language and culture barriers, communicate with management, publish a newsletter, spend time with campers doing intergenerational programing and more.
Since these programs’ inception, Janel Doughten, associate director of the Center for Senior Services, has taken over coordinating them, adding to the content and therefore value to the participants. Under Janel and our late co-worker Gene Fogel’s leadership, the annual staff training was expanded from just the managers to additional onsite staff including assistant managers, activity coordinators and service coordinators and is now called the B’nai B’rith Managers and Service Coordinators Training. The retreat was also expanded from three days to seven. These changes have provided for significantly more programing and training for additional staff and residents to bring back to their buildings. Due to the coronavirus pandemic, all training has moved to a virtual platform and has expanded to include a weekly Zoom meeting with the onsite building staff. Sharing ideas and best practices—especially during a nationwide emergency—is one of the main benefits of being part of our housing network.
During the year CSS will be highlighting our housing community through our media platforms. Expect video conversations between B’nai B’rith staff and volunteers discussing our organization’s rich history with affordable housing and the Resident Leadership Retreat. We intend on spotlighting our sponsored properties with fun facts and pictures, and interviews of our building’s board members and staff. Some of our staff and volunteers have been with the buildings since their creation. Also, it’s possible current B’nai B’rith residents could make an appearance to say hello and share their experiences.
Clearly there is lots to talk about and we are excited to share!
I have been privileged working at B’nai B’rith for the past four years, however my colleagues Mark and Janel have worked at the organization for 37 and 28 years, respectively. They rightfully talk about our senior housing program with pride. I hope during CSS’ 100th anniversary we will be able to highlight even more accomplishments in the name of affordable senior housing.
At B’nai B’rith we are a proud sponsor of affordable senior housing across the country. The goal of our Senior Housing Network is to provide seniors with quality, affordable housing in a secure, supportive community environment. What makes many of our buildings special are the service coordinators who work at the properties and connect residents with services in the community that allows seniors to age in place and not move to more costly facilities. Service coordinators play a vital role in the operation of our senior housing buildings, and their work has never been more critical than during the pandemic.
Prior to the virus, interacting with residents was a big part of service coordinators’ job. Obviously, given rules regarding social distancing, speaking with residents in close proximity has become problematic. Along with the limitations the pandemic has put on older Americans, the role of service coordination has dramatically changed. Recently, the American Association of Service Coordinators (AASC) and Harvard University’s Joint Center for Housing Studies issued a report entitled “For Older Adults in Publicly Funded Housing During the Pandemic, Service Coordinators Help Build Resilience,” detailing the ways service coordinators’ jobs have changed because of the virus. Results are based on surveys from service coordinators in June and July who are members of AASC, with 79 percent of those surveyed being people who work with individuals over 62 years old.
For starters, service coordinators have been asked to perform work left vacant by in-person or personal care assistants that normally help residents with housekeeping, laundry and dressing. Because of the pandemic, this type of assistance has not been as accessible to residents. In addition, the study reported that many residents did not have enough food, medicine and household supplies to isolate for a week. Consequently, service coordinators worked to remedy these problems, in part by reaching out to local donor organizations and distributing resources once it reached the property.
The study further reports that 74 percent of service coordinators found their residents exhibited more loneliness and anxiety. One service coordinator who was surveyed wrote, “I have had many conversations with residents who are very lonely, anxious and tired of being isolated. A lot of our residents have positive attitudes during this time, but it has taken a toll on their mental/emotional health. [I have] observed residents who are sad and feeling desperate to socialize.” In response, service coordinators encouraged residents to decorate their doors and created writing contests. In addition, these coordinators scheduled activities like scavenger hunts and bingo that allowed residents to enjoy themselves and practice social distancing.
Samara Scheckler, postdoctoral fellow at the Harvard Joint Center for Housing Studies and co-author of the study said, “For older adults living in publicly-funded housing, the early months of COVID-19 highlighted the critical role service coordinators played in maintaining the stability of resident housing and health through a period of major change. With interruptions in access to food, medicine, medical care, personal assistance and social supports, service coordinators filled in many gaps. They linked residents to community resources, managed public benefits, coordinated informal supports, facilitated residents’ access to and ability to use technology, communicated emerging public health guidance and knit together peer-support networks. Service coordinators ensured residents had access to the resources needed to manage their physical and mental health and maintain their housing through intense disruption.”
The study’s findings are similar to what the B’nai B’rith Center for Senior Services (CSS) is hearing from our Senior Housing Network. For instance, once the pandemic began we started a weekly B’nai B’rith Senior Housing Network Zoom call, and we held our yearly Senior Housing Conference and Managers and Service Coordinators Meeting virtually. These meetings provide a forum for property managers and service coordinators to share new ideas, hear success stories and speak directly with their colleagues across the country facing similar challenges. Also during these virtual meetings, issues such as social isolation were addressed using case studies and by providing resources through our website.
Furthermore, we were able to discuss COVID-19 related scams with our building staff. As an example, we showed an email where the sender claimed to be from the Federal Bureau of Investigation (FBI) and offered five million dollars in exchange for personal identifying information. Hat-tip to our sponsored building, B’nai B’rith Chesilhurst House, for bringing this scam to CSS’s attention and giving us the opportunity to make our network aware of the problem. The Harvard/AASC study also reported service coordinators making their residents aware of scams during the pandemic.
Throughout the pandemic, B’nai B’rith service coordinators have worked to combat social isolation and partner with community organizations to provide food to residents. B’nai B’rith Apartments in Allentown, Pennsylvania and Covenant House in Tucson, Arizona have worked with community partners to ensure residents have groceries during the pandemic. Building staff have packed up food and other supplies, and then coordinated to have them distributed to residents while practicing social distancing. Regarding social isolation, staff have orchestrated activities like painting, exercises classes and bingo, all in a safe and distant manner. Service coordinators in these buildings have also spent hours with residents on the phone and try to communicate with the residents in person when feasible.
With all the work being done by service coordinators in federally subsidized senior housing, it’s time for Congress to appropriate additional money to be used for more service coordinators and supplies. Keep in mind only around fifty percent of federally funded senior housing buildings eligible for a service coordinator have one, and even buildings with one could use the additional help. Funds should also be allocated for increasing Wi-Fi accessibility that would enable service coordinators to speak with building residents while practicing social distancing, as well as make it easier for residents to participate in telehealth. Since the pandemic started, B’nai B’rith and AASC have advocated to Congress for maximum funding for affordable senior housing to combat the negative consequences of the pandemic. Alayna Waldrum, consultant to AASC said, “Service coordinators have been essential to the success of affordable senior housing across the country, and during the pandemic. It is imperative that Congress appropriates additional funding for resources to provide for more personal protective equipment, emergency service coordinators and increased Wi-Fi availability in senior properties. These resources would help alleviate some of the negative impacts of the virus and resulting isolation.”
Everyone who works with a service coordinator should take a second and appreciate the invaluable service they have performed during the pandemic. It’s not surprising that CSS has found our Senior Housing Network’s service coordinators’ experiences run parallel to the AASC/Harvard study. Ensuring residents have food, supplies, medicine and don’t suffer from social isolation are common themes. Service coordinators around the country have answered the call to best serve their residents during the pandemic and deserve our heartfelt gratitude.
As we are approaching the one-year anniversary of the pandemic, it is clear that businesses have struggled to manage the effects, including the disparate policies used with their workers. As referenced in my blog "Social Security: 85 Years of Lifting Seniors out of Poverty," the pandemic has caused less payroll tax to be collected, thereby decreasing revenue to Social Security and consequently decreasing the life of the Trust Fund. Furthermore, President Donald Trump over the summer signed an executive order impacting the solvency of the Trust Fund by deferring payroll taxes for the rest of the year and advocated for the cuts to be permanent. B’nai B’rith International expressed disappointment with the executive order because the payroll tax is a significant source of revenue for Social Security and any potential cuts will erode one of our nation’s most important programs for seniors.
With the White House transitioning from a Trump to Biden administration, it’s important to examine how President-elect Biden’s proposed policies could impact Social Security. First, over the summer Biden campaigned against cuts to the payroll tax. Despite the pandemic, at least Social Security shouldn’t see any further decreases to revenue by a payroll tax cut.
Secondly, Biden proposed important changes to Social Security that could impact revenue and expenses, however, according to the Urban Institute does not solve Social Security’s long-term problem of being able to pay all of its obligations. Biden campaigned on increasing Social Security benefits for widows, people 78 to 82 years old and for certain low-income workers such as people who have worked more than 30 years. Former Senator Tom Harkin and Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, said in the Des Moines Register, "The nonpartisan Social Security Administration has projected that a single provision of the Biden plan — increasing the minimum beneﬁt for low-income, lifetime workers — would lift more than one-half million seniors out of poverty by 2030."
Regarding the revenue to pay for these proposals, according to the Urban-Brookings Tax Policy Center Biden proposed a payroll tax increase for income above $400,000 a year that could generate $740 billion in revenue over ten years. It’s important to remember that people are only taxed on wages up to $137,700 for the purposes of Social Security.
Another component of Biden’s plan would potentially allow people that serve as caregivers for family members who are young or have a disability to earn Social Security credits. This would reward family caregivers who are being unfairly punished for the purposes of earning Social Security at retirement. Similar to Biden’s other proposal referenced above, the plan would be funded by raising taxes on real estate investors whose incomes exceed $400,000 a year and, according to the campaign by, "taking steps to increase tax compliance for high-income earners."
The original purpose of Social Security was to lift seniors out of poverty. By providing needed increases to Social Security benefits, and not raising taxes on middle and low-income individuals, Biden’s proposals should be given consideration by Congress. Unfortunately, we know that life in politics is never that simple. While I expect some possible bi-partisan cooperation in Congress around COVID-19 stimulus legislation, it remains unclear what other legislation can be signed into law. However, here is to hoping a bi-partisan agreement can be reached in Congress that benefits seniors throughout the country.
At his 2017 Senate hearing to become a Supreme Court Justice, Neil Gorsuch was questioned by Sen. Dianne Feinstein (D-California) regarding physician assisted death (PAD). Feinstein and Gorsuch each articulated their position on this contentious issue, serving as a microcosm for our nation’s larger debate. Should doctors be allowed to prescribe end-of-life medication to terminally ill patients to ease their suffering?
In 1994, Oregon became the first state in our country to legalize PAD by passing the Death with Dignity Act. Since then, eight states and the District of Columbia have similar laws. Generally speaking, states require patients to have a terminal illness and have less than six months to live to be prescribed end-of-life medication.
Given the sensitive nature of this topic, people have strong feelings on either side. Opponents contend that a doctor’s prognosis is not a certainty and that these laws could lead to insurance companies weighing in on end of life matters. Additionally, the patients in question might be suffering from psychological distress.
Proponents of PAD advocate that people shouldn’t be forced to physically suffer and should have the right to choose to end terminal pain on their terms. Advocates say that with only a few months left to live nobody should be forced to needlessly suffer.
Data from around the country suggests that states which allow PAD have not been used in great numbers because this practice contributes to significantly less than a percentage point of deaths. Furthermore, Hawaii’s PAD law and a proposed PAD law in Massachusetts have a mental health consultation component. Plus, patients requesting PAD must be able to understand the nature of their decision to be given end-of-life medication.
Kaiser Health News reported about Charlie and Francie Emerick, married for 66 years, who each had terminal illness and availed themselves of Oregon’s Death with Dignity law. Charlie suffered from prostate cancer and Parkinson’s disease and Francie from a weakened heart after numerous heart attacks and cancer. “You keep going, Charlie, you’re going to get worse and worse and worse,” Charlie explained about his decision, “The other can’t be worse than this.” Before being prescribed end-of-life medication, Charlie and Francie both attested to their intentions and were examined by two different doctors who concluded they had less than six months to live. Ultimately, they decided they wanted to say goodbye on their own terms. Their story was recorded as a documentary to show how the process is carried out so people would understand more about PAD.
Traditionally, there is a widely held belief that PAD breaks with Jewish law, though there is a debate in the Jewish community about whether the issue should be revisited. Last year New Jersey legalized PAD, causing a debate among rabbis about whether to support the legislation. Rabbi Mark Mallach argued that the prevailing view in the conservative Jewish movement surrounding PAD should be reconsidered and told the New Jersey Jewish News (NJJN), “Jewish law has always been organic, responding to the needs of society in every generation,” and said, “Jewish law is not frozen.” However, Rabbi Elie Mischel took a different approach telling the NJJN, “Actively speeding one’s death is clearly forbidden under Jewish law (for both Jews and gentiles), and it is a rejection of the sanctity of every moment of life.” He also said, “Though we are not obligated to do everything humanly possible to prolong someone’s life (e.g., a very ill patient has the right to forgo a risky and painful surgery that has little chance to succeed), actively taking one’s own life is never permissible.”
As more states in our country debate PAD legislation, I expect these discussions to continue as people examine where they stand on this issue. Whichever side people come down on, I suspect this matter will generate intense debate in our national discourse.
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