Public Housing
Distressed Conditions in Developments for the Elderly and Persons with Disabilities and Strategies Used for Improvement Gao ID: GAO-06-163 December 9, 2005In 2003, Congress reauthorized HOPE VI, a program administered by the Department of Housing and Urban Development (HUD) and designed to improve the nation's worst public housing. In doing so, Congress required GAO to report on the extent of severely distressed public housing for the elderly and non-elderly persons with disabilities. "Severely distressed" is described in the statute as developments that, among other things, are a significant contributing factor to the physical decline of, and disinvestment in, the surrounding neighborhood; occupied predominantly by very low-income families, the unemployed, and those dependent on public assistance; have high rates of vandalism and criminal activity; and/or lack critical services, resulting in severe social distress. In response to this mandate, GAO examined (1) the extent to which public housing developments occupied primarily by elderly persons and non-elderly persons with disabilities are severely distressed and (2) the ways in which such housing can be improved. HUD officials provided oral comments indicating general agreement with the report.
Available data on the physical and social conditions of public housing are insufficient to determine the extent to which developments occupied primarily by elderly persons and non-elderly persons with disabilities are severely distressed. Using HUD's data on public housing developments--buildings or groups of buildings--and their tenants, GAO identified 3,537 developments primarily occupied by elderly residents and persons with disabilities. Data from HUD and other sources indicated that 76 (2 percent) of these 3,537 developments were potentially severely distressed. To gather more information on the 76 developments that were potentially distressed, GAO surveyed public housing agency directors responsible for these developments. GAO received responses covering 66 of the 76 developments (the survey and aggregated results are available in GAO-06-205SP). These responses indicated the following: (1) eleven developments had signs of severe physical distress, such as deterioration of aging buildings and a lack of accessible features for persons with disabilities; (2) another twelve developments had signs of severe social distress, which included a lack of appropriate supportive services such as transportation or assistance with meals; and (3) an additional five developments had characteristics of both severe physical and social distress. Nevertheless, many of the directors GAO surveyed reported that numerous factors adversely affected the quality of life of elderly persons and non-elderly persons with disabilities residing in their developments. The factors cited most frequently were (1) aging buildings and systems, including inadequate air conditioning; (2) lack of accessibility for persons with disabilities; (3) small size of apartments; (4) the mixing of elderly and non-elderly residents; (5) inadequate supportive services; and (6) crime. To better address the special needs of the elderly and non-elderly persons with disabilities, public housing agency officials GAO surveyed or contacted have used various strategies to improve both physical and social conditions at their developments. Strategies to reduce physical distress include capital improvements such as renovating buildings, systems, and units or, in extreme cases, relocating residents and demolishing or selling a development. Methods to reduce the level of social distress include a range of actions, such as designating developments as "elderly only," converting developments into assisted living facilities, and working with other governmental agencies and nonprofit organizations to provide supportive services to residents.
GAO-06-163, Public Housing: Distressed Conditions in Developments for the Elderly and Persons with Disabilities and Strategies Used for Improvement
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Report to Congressional Committees:
December 2005:
Public Housing:
Distressed Conditions in Developments for the Elderly and Persons with
Disabilities and Strategies Used for Improvement:
GAO-06-163:
GAO Highlights:
Highlights of GAO-06-163, a report to congressional committees:
Why GAO Did This Study:
In 2003, Congress reauthorized HOPE VI, a program administered by the
Department of Housing and Urban Development (HUD) and designed to
improve the nation‘s worst public housing. In doing so, Congress
required GAO to report on the extent of severely distressed public
housing for the elderly and non-elderly persons with disabilities.
’Severely distressed“ is described in the statute as developments that,
among other things, are a significant contributing factor to the
physical decline of, and disinvestment in, the surrounding
neighborhood; occupied predominantly by very low-income families, the
unemployed, and those dependent on public assistance; have high rates
of vandalism and criminal activity; and/or lack critical services,
resulting in severe social distress.
In response to this mandate, GAO examined (1) the extent to which
public housing developments occupied primarily by elderly persons and
non-elderly persons with disabilities are severely distressed and (2)
the ways in which such housing can be improved.
HUD officials provided oral comments indicating general agreement with
the report.
What GAO Found:
Available data on the physical and social conditions of public housing
are insufficient to determine the extent to which developments occupied
primarily by elderly persons and non-elderly persons with disabilities
are severely distressed. Using HUD‘s data on public housing
developments”buildings or groups of buildings”and their tenants, GAO
identified 3,537 developments primarily occupied by elderly residents
and persons with disabilities. Data from HUD and other sources
indicated that 76 (2 percent) of these 3,537 developments were
potentially severely distressed. To gather more information on the 76
developments that were potentially distressed, GAO surveyed public
housing agency directors responsible for these developments. GAO
received responses covering 66 of the 76 developments (the survey and
aggregated results are available in GAO-06-205SP). These responses
indicated the following:
* Eleven developments had signs of severe physical distress, such as
deterioration of aging buildings and a lack of accessible features for
persons with disabilities;
* Another twelve developments had signs of severe social distress,
which included a lack of appropriate supportive services such as
transportation or assistance with meals; and
* An additional five developments had characteristics of both severe
physical and social distress.
Nevertheless, many of the directors GAO surveyed reported that numerous
factors adversely affected the quality of life of elderly persons and
non-elderly persons with disabilities residing in their developments.
The factors cited most frequently were (1) aging buildings and systems,
including inadequate air conditioning; (2) lack of accessibility for
persons with disabilities; (3) small size of apartments; (4) the mixing
of elderly and non-elderly residents; (5) inadequate supportive
services; and (6) crime.
To better address the special needs of the elderly and non-elderly
persons with disabilities, public housing agency officials GAO surveyed
or contacted have used various strategies to improve both physical and
social conditions at their developments. Strategies to reduce physical
distress include capital improvements such as renovating buildings,
systems, and units or, in extreme cases, relocating residents and
demolishing or selling a development. Methods to reduce the level of
social distress include a range of actions, such as designating
developments as ’elderly only,“ converting developments into assisted
living facilities, and working with other governmental agencies and
nonprofit organizations to provide supportive services to residents.
www.gao.gov/cgi-bin/getrpt?GAO-06-163.
www.gao.gov/cgi-bin/getrpt?GAO-06-205SP.
To view the full product, including the scope, methodology, and related
survey, click on the links above. For more information, contact David
G. Wood at (202) 512-8678 or woodd@gao.gov.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
While Comprehensive Data Are Lacking to Determine Extent of Severe
Distress, Public Housing Directors Reported Adverse Social and Physical
Conditions:
Various Strategies Could Improve Physical and Social Conditions at
Public Housing for the Elderly and Non-Elderly Persons with
Disabilities:
Observations:
Agency Comments:
Appendixes:
Appendix I: Objectives, Scope, and Methodology:
Appendix II: Technical Methodology:
Appendix III: Description of Site Visits to Two of HUD's Innovative
Models in Public Housing for the Elderly:
Homestead Apartments:
Helen Sawyer Plaza:
Appendix IV: GAO Contact and Staff Acknowledgments:
Table:
Table 1: Point System and Indicators Used in Our Distress Index:
Figures:
Figure 1: Percent of Public Housing Units Occupied by the Elderly and
Non-Elderly Persons with Disabilities
Figure 2: Level of Deterioration of Physical Structures, According to
Public Housing Directors
Figure 3: Conditions Most Frequently Cited as Adversely Affecting the
Elderly and Persons with Disabilities and Challenges Most Frequently
Cited in Providing Public Housing
Figure 4: Signs of Severe Physical Distress Include Deteriorating
Infrastructure Such as Concrete Surfaces
Figure 5: Inadequate Shelter, Such as Exterior Walkways at a High-Rise
Development, Exposes Residents to the Elements
Figure 6: Most Developments Are Undergoing or Will Need Demolition,
Replacement, or Rehabilitation
Figure 7: Examples of Lack of Access for the Elderly and Persons with
Disabilities Include Narrow Hallways and Elevators That Cannot Easily
Accommodate Wheelchairs or Scooters
Figure 8: Number of Developments with Supportive Services Available On-
Site for Elderly Residents
Figure 9: Access to a Service Coordinator
Figure 10: Extent of Crime Problem in and near Developments:
Figure 11: The Local Housing Agency Completely Rebuilt Historic Village
to Improve Conditions
Figure 12: Physical Therapy Area at the Community LIFE Center
Figure 13: Commercial Kitchen Space at Helen Sawyer Plaza:
Abbreviations:
HUD: Department of Housing and Urban Development:
LIFE: Living Independently for Elders:
MTW: Moving to Work:
PACE: Program of All-Inclusive Care for the Elderly:
PIC: Public and Indian Housing Information Center:
REAC: Real Estate Assessment Center:
ROSS: Resident Opportunities and Self Sufficiency:
UPMC: University of Pittsburgh Medical Center:
Letter December 9, 2005:
The Honorable Richard C. Shelby:
Chairman:
The Honorable Paul S. Sarbanes:
Ranking Minority Member:
Committee on Banking, Housing, and Urban Affairs:
United States Senate:
The Honorable Wayne Allard:
Chairman:
The Honorable Jack Reed:
Ranking Minority Member:
Subcommittee on Housing and Transportation:
Committee on Banking, Housing, and Urban Affairs:
United States Senate:
The Honorable Michael G. Oxley:
Chairman:
The Honorable Barney Frank:
Ranking Minority Member:
Committee on Financial Services:
House of Representatives:
The Honorable Robert W. Ney:
Chairman:
The Honorable Maxine Waters:
Ranking Minority Member:
Subcommittee on Housing and Community Opportunity:
Committee on Financial Services:
House of Representatives:
By the year 2020, one in six Americans will be 65 years or older. Just
as our citizens are aging, so is the nation's stock of public housing
for the elderly and non-elderly persons with disabilities. Most public
housing was constructed in the 1960s and 1970s and has not been adapted
to meet the needs of a growing number of residents who are frail or
have disabilities. The needs of these residents present public housing
agencies with unique challenges in providing safe and decent housing,
compared with the needs of residents of family housing. For example,
the elderly and persons with disabilities need features such as wider
hallways and doorways, wheelchair ramps, or lowered countertops; aging
buildings that are physically and functionally obsolete are unable to
meet these needs. However, public housing developments are still an
affordable housing resource for low-income elderly persons and persons
with disabilities who otherwise have few housing options due to their
limited resources and incomes.
In 1992, the National Commission on Severely Distressed Public Housing
reported that 6 percent of existing public housing units, about 86,000
units, were in "severely distressed" condition.[Footnote 1] The
commission described "severely distressed" as public housing that had
one or more of the following conditions: physical deterioration of
buildings, serious crime in the development or surrounding
neighborhood, inadequate management, or a high concentration of very
low-income residents living on a small site. To improve severely
distressed public housing, the commission recommended physical and
management improvements, in addition to social and community services
to address resident needs. As a result of the commission's
recommendations, in fiscal year 1993, Congress enacted the HOPE VI
program, which defined severe distress and was intended to revitalize
the nation's severely distressed public housing.[Footnote 2] In 2003,
Congress expanded the statutory definition of "severely distressed
public housing" for the purpose of HOPE VI to include indicators of
social distress, such as a lack of supportive services and economic
opportunities.[Footnote 3] According to professionals knowledgeable
about the housing needs of the elderly and non-elderly persons with
disabilities, public housing developments that lack accessibility
features, social and recreational activities, or isolate residents in
their apartments can produce severely distressed living conditions.
In the HOPE VI Program Reauthorization and Small Community Mainstreet
Rejuvenation and Housing Act of 2003, Congress reauthorized the HOPE VI
program through 2006.The act also mandated that we report on the extent
of severely distressed public housing for the elderly and non-elderly
persons with disabilities and make recommendations for improving this
housing, considering the special needs of the elderly and non-elderly
persons with disabilities.[Footnote 4] After consultations with your
offices, we addressed the mandate by examining (1) the extent to which
public housing developments occupied primarily by elderly persons and
non-elderly persons with disabilities were severely distressed and (2)
the ways in which the stock of severely distressed public housing for
the elderly and non-elderly persons with disabilities can be improved.
To address these objectives, we interviewed officials from the U.S.
Department of Housing and Urban Development (HUD) and reviewed relevant
laws and regulations to determine the criteria for severely distressed
public housing. We analyzed data (obtained in January 2005) from HUD's
Public and Indian Housing Information Center (PIC) database to
determine how many public housing developments were occupied primarily
by elderly persons or non-elderly persons with disabilities. We met
with HUD officials to establish the reliability of the PIC data,
conducted our own data reliability testing, and concluded that the data
were sufficiently reliable for purposes of this report. We focused our
analysis on housing "developments" because much of the available data
were at the development level rather than the individual building or
unit level. (A development can be a collection of buildings, located
near each other or scattered geographically, or an individual
building.) As a result, our analysis does not necessarily include all
public housing units that are occupied by elderly persons or non-
elderly persons with disabilities, because such units may be located in
developments that are occupied primarily by residents other than the
elderly or persons with disabilities. The developments occupied
primarily by elderly persons or non-elderly persons with disabilities,
according to HUD's data, represent 27 percent of all public housing
developments in the nation. To determine the extent to which these
developments were "severely distressed," we first created an index of
distress using eight indicators, including physical characteristics
(such as building age) as well as social characteristics (such as the
poverty level in the surrounding area). Using data from HUD's PIC
system, we computed a distress score for each development and
considered those that scored high on our distress index to be
potentially "severely distressed."[Footnote 5] To obtain detailed
information about the condition of these potentially distressed
developments and information on strategies for improving distressed
conditions, we sent surveys to the directors of the 46 public housing
agencies that operate the developments. We received responses from 43
directors. In addition, we visited 25 developments. To determine the
special housing needs of elderly persons and non-elderly persons with
disabilities, as well as strategies to improve severely distressed
public housing for these residents, we interviewed individuals
knowledgeable about these issues. We also reviewed applicable reports
by federal agencies and interest groups. We interviewed public housing
agency officials, and included questions in the survey about the
strategies that have been used to improve severely distressed public
housing. We did not evaluate the effectiveness of one improvement
strategy over another; therefore, in this report, we only describe the
approaches housing agency officials used to improve distressed
conditions. For a more detailed explanation of our scope and
methodology, see appendixes I and II. The survey and the aggregated
results can be viewed at [Hyperlink, http://www.gao.gov/cgi-
bin/getrpt?GAO-06-205SP].
We conducted our work in Washington, D.C; Miami and St. Petersburg,
Florida; Homestead, New Castle, and Pittsburgh, Pennsylvania;
Evansville, Indiana; St. Louis, Missouri; Seattle, Washington; and
Oakland and San Francisco, California, between November 2004 and
October 2005 in accordance with generally accepted government auditing
standards.
Results in Brief:
Available data on the physical and social conditions of public housing
developments are insufficient to determine the extent of severe
distress among units occupied by elderly persons and non-elderly
persons with disabilities. According to our analysis of HUD's limited
data, 3,537 public housing developments were occupied primarily by such
residents, and 76 of these had characteristics indicating potential
severe distress. Based on the survey responses we received from public
housing directors, covering 66 developments with indications of
potential distress, we found that:
* Eleven developments had characteristics that indicated severe
physical distress, such as deteriorated building systems and a lack of
accessibility features for persons with disabilities;
* Another twelve developments had signs of severe social distress,
including a lack of appropriate supportive services such as access to
transportation and assistance with meals; and:
* An additional five developments had characteristics that indicated
both severe physical and social distress.
Even if not considered severely distressed, developments may have
conditions that adversely affect the quality of life of the elderly and
non-elderly persons with disabilities. Many of the public housing
directors we surveyed reported a number of such conditions, citing most
frequently (1) aging buildings and systems, including inadequate air-
conditioning; (2) lack of accessibility for persons with disabilities;
(3) small size of apartments; (4) the mixing of elderly and non-elderly
residents; (5) inadequate supportive services; and (6) crime.
To better address the special needs of the elderly and non-elderly
persons with disabilities, public housing agency officials we contacted
have used various strategies to improve both physical and social
conditions at their developments. Strategies to reduce physical
distress include capital improvements such as renovating buildings,
systems, and units or, in extreme cases, relocating residents and
demolishing or selling a development. Methods to reduce the level of
social distress include designating developments as "elderly only,"
converting developments into assisted living facilities, and working
with other governmental agencies and nonprofit organizations to provide
supportive services to residents.
We provided a draft of this report for HUD's review. HUD provided oral
comments, generally agreeing with our report, and technical comments,
which we incorporated as appropriate.
Background:
Under the United States Housing Act of 1937, as amended, Congress
created the federal public housing program to provide decent and safe
rental housing for eligible low-income families, the elderly, and
persons:
with disabilities.[Footnote 6] HUD administers federal aid to local
public housing agencies that manage housing for low-income residents at
rents they can afford. More specifically, 3,150 public housing agencies
manage approximately 1.2 million public housing units throughout the
nation, of which approximately 1 million are occupied. Public housing
comes in all sizes and types, from scattered single-family houses to
high-rise apartments.
Funding for public housing construction, renovation, or operation can
come from a number of HUD programs, as well as other government and
private sources. HUD's Public Housing Capital Fund (Capital Fund)
provides funds (distributed by formula) for activities such as
redesign, reconstruction, improvement of accessibility, and replacement
of obsolete utility systems.[Footnote 7] The fiscal year 2005
appropriation for the Capital Fund was about $2.4 billion. HUD's Public
Housing Operating Fund (Operating Fund) provides operating subsidies to
housing agencies to help them meet operating and management expenses.
The fiscal year 2005 appropriation for the Operating Fund was about
$2.4 billion. In addition, between fiscal years 1993 and 2005, Congress
appropriated $6.8 billion for the HOPE VI program, which HUD awarded to
public housing agencies for planning, technical assistance,
construction, rehabilitation, demolition, and housing choice voucher
assistance. While most of the funds are intended for capital costs, a
portion of the revitalization grants may be used for community and
supportive services. In addition, public housing agencies use the HOPE
VI revitalization grant to leverage additional funds from sources such
as other HUD funds, state or local contributions, or public and private
loans. In 2002, we reported that housing agencies expected to leverage--
for every dollar received in HOPE VI revitalization grants awarded
through fiscal year 2001--an additional $1.85 in funds from other
sources.[Footnote 8] We also found that housing agencies that had
received revitalization grants expected to leverage $295 million in
additional funds for community and supportive services. In addition to
leveraging funds from a variety of sources, housing agencies may use
Low-Income Housing Tax Credits--which are federal tax credits for the
acquisition, rehabilitation, or new construction of affordable rental
housing--as well as Medicaid Home and Community-Based Services waivers,
which allow flexibility in providing healthcare or long-term care
services to Medicaid-eligible individuals outside of an institutional
setting.[Footnote 9]
Residents of public housing who are elderly or have disabilities may
have more special needs, compared with other residents, due to their
age and type of disability. According to a 2002 study by the Housing
Research Foundation, elderly public housing residents are more likely
to be "frail" or have disabilities, compared with other elderly persons
not living in public housing.[Footnote 10] The researchers reported
that more than one in five elderly public housing residents were
classified as persons with disabilities, compared with only 13 percent
of U.S. elderly persons. In addition, the report found that over 30
percent of elderly public housing residents have at least one
functional problem, such as difficulty with cooking, seeing, and
hearing, compared with just over 20 percent of all elderly persons.
Some elderly persons or persons with disabilities may require
assistance with the basic tasks of everyday life, such as eating,
bathing, and dressing. In addition, the needs of the elderly or persons
with disabilities result in a need for physical features in residences
that adequately accommodate physical limitations.
According to 2005 HUD data, 64 percent of the approximately 1 million
occupied public housing units are occupied by at least one elderly
person or a person with a disability, and 50 percent of all heads of
public housing households are either elderly (31 percent) or non-
elderly persons with disabilities (19 percent), as shown in figure 1.
Figure 1: Percent of Public Housing Units Occupied by the Elderly and
Non-Elderly Persons with Disabilities:
[See PDF for image]
Note: See appendix I for a discussion of the limitations of the data.
[End of figure]
Residents who are elderly or have disabilities live in a variety of
public housing settings, including developments that are occupied
primarily by elderly residents or residents with disabilities as well
as developments that are occupied primarily by families.[Footnote 11]
According to 2005 HUD data, of approximately 500,000 public housing
units that are occupied by a head of household who is elderly or has a
disability, 47 percent are in developments that are occupied primarily
by elderly persons or persons with disabilities, 40 percent are in
developments that are occupied primarily by families (family housing
developments), and 13 percent are in developments that include
buildings that are occupied by families and buildings that are occupied
by elderly persons and persons with disabilities (mixed developments).
While Comprehensive Data Are Lacking to Determine Extent of Severe
Distress, Public Housing Directors Reported Adverse Social and Physical
Conditions:
While HUD collects data for several elements describing the physical
and social conditions that exist at its public housing developments,
the data do not sufficiently establish whether a housing development is
severely distressed. Based on survey responses from public housing
directors--covering 66 housing developments with indications of
potential distress and occupied primarily by the elderly or persons
with disabilities--we found that 11 developments exhibited signs of
severe physical distress; 12 had signs of severe social distress; and
an additional 5 developments had signs of both severe physical and
social distress. Although the remainder of the 66 developments had
fewer signs of severe distress, the public housing directors we
surveyed pointed out several conditions that adversely affected the
quality of life for their tenants who are elderly or have disabilities.
The factors they most frequently cited were (1) aging buildings and
systems, including inadequate air-conditioning; (2) lack of
accessibility for residents with disabilities; (3) small studio
apartments; (4) tension between elderly residents and non-elderly
residents with disabilities; (5) lack of supportive services; and (6)
security and crime issues.
HUD Maintains Limited Data about the Condition of Public Housing for
the Elderly and Persons with Disabilities:
As previously discussed, Congress expanded the statutory definition of
"severely distressed public housing" in 2003 to include, among other
factors, housing developments in severe distress because of a lack of
sufficient appropriate transportation, supportive services, economic
opportunity, schools, civic and religious institutions, and public
services. However, HUD data do not indicate whether a development has
these kinds of public and other supportive services.
HUD collects, maintains, and analyzes data on public housing primarily
through a database system and a management center. HUD uses the Public
and Indian Housing Information Center (PIC) system--which was designed
to facilitate Web-based exchange of data between public housing
agencies and local HUD offices--to monitor the housing agencies, detect
fraud, and analyze and provide information to Congress and other
interested parties. PIC contains a detailed inventory of public housing
units and tenant (household) information about occupants. For example,
the PIC database maintains information on the number of developments
and units, age of the development, extent to which apartment units are
accessible for persons with disabilities, and tenant information such
as the age, disability status, and income of families who participate
in public housing programs.[Footnote 12] HUD's Real Estate Assessment
Center (REAC) monitors and evaluates the physical condition of public
housing and other properties that receive financial assistance from HUD
and also assesses their financial condition.[Footnote 13] For example,
the Physical Assessment Subsystem within REAC maintains information
about the physical condition of HUD properties, based on on-site
physical inspections, which identifies housing developments that are
physically deteriorated, have health and safety hazards, or
deficiencies such as tripping hazards on sidewalks or parking lots,
damaged fences or gates, blocked emergency exits, or inoperable smoke
detectors inside apartments.[Footnote 14]
Relatively Few Developments Primarily Occupied by the Elderly and Non-
Elderly Persons with Disabilities Appeared Potentially Severely
Distressed:
Using the limited data that were available from HUD and other sources,
we defined eight measures to indicate potential severe distress for
developments: (1) REAC physical inspection results; (2) adjusted
physical inspection results provided by the Urban Institute; (3)
building age; (4) vacancy rate; (5) total household income by unit; (6)
poverty rate for the census tract; (7) accessibility of units to
persons with disabilities; and (8) whether developments applied for
HOPE VI or were approved for demolition, disposition, or HOPE VI
funding.[Footnote 15] As noted previously, we then developed an "index
of distress" to score conditions at public housing
developments.[Footnote 16] We found that 76 (2 percent) of the 3,537
housing developments mainly occupied by the elderly and non-elderly
persons with disabilities showed indications of severe
distress.[Footnote 17] In contrast, other developments were more likely
to show indications of severe distress. We found that 958 (12 percent)
of 7,932 family housing developments and 69 (15 percent) of 466 mixed
housing developments showed indications of severe distress. In
addition, some public housing directors we interviewed reported that
family housing developments, near or adjacent to their developments
occupied primarily by elderly residents and residents with
disabilities, were more likely to be in worse condition or afflicted by
neighborhood crime or illicit activities.
According to HUD's data, the following characteristics describe the 76
housing developments that were occupied by mostly elderly persons and
non-elderly persons with disabilities:
* 21 had been approved for demolition, disposition, or HOPE VI
revitalization;
* 72 had a building that was more than 30 years old;
* 64 had few units (less than 5 percent) that met accessibility
standards;[Footnote 18]
* 24 had a physical inspection score under 60 percent;[Footnote 19]
* 41 were in a census tract with a poverty rate greater than 35
percent; and:
* 26 had households with a total median income under $7,000.
Even If Not Severely Distressed, Public Housing Developments May Pose
Problematic Living Conditions for the Elderly and Non-Elderly Persons
with Disabilities:
Responses to our survey of public housing directors indicated that some
of the 76 public housing developments occupied primarily by elderly
persons and non-elderly persons with disabilities were severely
distressed and that, among those that were not, certain characteristics
nevertheless adversely affected the quality of life for their
residents. We received responses covering 66 of these 76 developments
and found that 11 showed signs of severe physical distress, 12 had
signs of severe social distress, and five others had signs of both
physical and social distress. In developments where survey data
indicated signs of severe distress, housing directors reported
deterioration and obsolescence in key systems. However, housing
directors described the condition of the physical structures at 34
developments as either, "not at all deteriorated" or "a little
deteriorated" (see fig. 2). Indicators of severe social distress that
the directors reported include inadequate supportive services, such as
transportation, assistance with meals, and problems with crime.
Figure 2: Level of Deterioration of Physical Structures, According to
Public Housing Directors:
[See PDF for image]
Note: For this survey item, we received responses for 62 developments.
[End of figure]
Even though not necessarily indicative of severe distress, a number of
factors were reported by many public housing agency directors as
adversely affecting living conditions for the elderly and persons with
disabilities. Among the most frequently cited characteristics or
conditions were aging buildings, lack of accessibility for residents
with disabilities, small size of apartments, mixing elderly and non-
elderly residents with disabilities, the lack of supportive services,
and crime. To varying extents, the survey respondents also cited these
factors as challenges in providing public housing (see fig. 3).
Figure 3: Conditions Most Frequently Cited as Adversely Affecting the
Elderly and Persons with Disabilities and Challenges Most Frequently
Cited in Providing Public Housing:
[See PDF for image]
Note: Based on survey responses from 41 public housing agency directors
covering 64 developments. Responses are from open-ended survey items;
therefore, in some cases, directors reported multiple challenges--
including those that directors encountered over the past 15 years.
[End of figure]
Aging Buildings:
Eleven surveyed housing agency directors mentioned that aging buildings
posed maintenance and other challenges for their housing agencies--
nearly all (96 percent) of the developments that we surveyed were more
than 30 years old. Some buildings had deteriorating structures, as
shown in figure 4. In addition, several public housing agency officials
further noted during our site visits and in our survey that because of
their age, the developments were "functionally obsolete." That is, many
of the design features were outdated and did not meet the needs of
residents. For example, 11 of the survey responses cited lack of
adequate air-conditioning as a condition that most adversely affected
the elderly and persons with disabilities. The building manager at one
development said that during the summer months some elderly tenants who
have heart conditions face increased health risks because their
apartments do not have air-conditioning. At another development, an
antiquated steam system provided heating. The public housing agency
official whom we spoke with said this contributed to exorbitant utility
bills. In addition to outdated systems, housing agency officials also
cited outdated building designs as affecting the quality of life. For
example, we visited two high-rise buildings that were more than 30
years old and constructed with exterior walkways, which residents had
to use to access their apartments. During the winter months residents
were routinely exposed to extremely cold weather and snow (see fig. 5).
In addition, one public housing agency official whom we spoke with said
that high-rise buildings limit social interactions among elderly
residents.
Figure 4: Signs of Severe Physical Distress Include Deteriorating
Infrastructure Such as Concrete Surfaces:
[See PDF for image]
[End of figure]
Figure 5: Inadequate Shelter, Such as Exterior Walkways at a High-Rise
Development, Exposes Residents to the Elements:
[See PDF for image]
[End of figure]
Due to the age of the buildings, public housing agency directors who
responded to our survey reported that most of the 66 developments were
undergoing, or will need, demolition, replacement, renovation, or
rehabilitation (see fig. 6). Of the 66 developments for which we
received responses, 11 were or are going to be demolished or replaced;
and 21 had building systems (such as air-conditioning and elevator
systems) that were recently or currently are being renovated; while 28
developments will require renovation to building systems within 3
years, according to housing agency directors. Respondents most
frequently indicated that plumbing and sewer systems, elevators, and
exterior building doors required near-term replacement or renovation.
Other systems or features that were cited nearly as frequently were
site lighting, parking lots, and heating and hot water systems.
(Because our survey targeted developments that were most likely to be
distressed, these conditions may not be representative of public
housing for the elderly and persons with disabilities in general.)
Figure 6: Most Developments Are Undergoing or Will Need Demolition,
Replacement, or Rehabilitation:
[See PDF for image]
Note: GAO analysis based on responses to multiple survey questions,
including whether development has been demolished or disposed of,
extent of and reasons for physical deterioration, status of renovation
to various building systems, and actions taken or planned to address
current conditions. For these survey items, we received responses for
66 developments.
[End of figure]
Lack of Accessibility:
Public housing agency directors reported that a lack of accessibility
throughout their developments was one condition that most adversely
affected the quality of life for the elderly and persons with
disabilities. For example, directors reported that 13 developments had
elevators that were not large enough to allow a person in a wheelchair
to easily turn around (see fig. 7). Our survey results also found that
some developments did not have entrance and lobby doorways wide enough
to allow passage for a person in a wheelchair or power scooter. We
visited one housing development that had hallways on the main floor
that were too narrow for modern power scooters to pass one another.
According to a public housing agency official from this development,
narrow halls are a problem because about one-third of the residents at
the housing development use power scooters. This development also had a
wheelchair ramp at the building's entrance that was too narrow for
power scooter users to easily navigate, and we observed power scooter
users making difficult three-point turns on the narrow ramp.
Additionally, six developments we surveyed did not have ramps of any
kind for persons using wheelchairs or power scooters. Moreover,
according to our survey, 23 developments had entrance and lobby
hallways without grab bars. According to professionals knowledgeable
about the housing needs of the elderly and persons with disabilities,
grab bars or hand-rails in hallways are important because they help
prevent falls, which are potentially disabling or fatal events. Based
on our survey responses, housing agency directors for 32 developments
indicated less than 5 percent of their units were accessible. During
our visit to one housing development, the building manager told us that
none of the apartment units were accessible to persons with
disabilities; therefore, prospective residents with special needs were
referred to another building within the housing agency's portfolio.
Figure 7: Examples of Lack of Access for the Elderly and Persons with
Disabilities Include Narrow Hallways and Elevators That Cannot Easily
Accommodate Wheelchairs or Scooters:
[See PDF for image]
[End of figure]
Size of Apartments, Particularly Studio Apartments:
Housing directors reported that small studio apartments adversely
affected the quality of life at six developments for the elderly and
persons with disabilities and represented a major challenge for five
housing agencies. One of the building managers that we interviewed
noted that elderly residents who live in studio apartments sometimes do
not have enough room for a lifetime's worth of possessions and often
have difficulty finding space for other family members, such as
grandchildren, for whom the residents may serve as primary caregivers.
Resident Mix:
In response to our survey, 17 public housing agency directors reported
that a mixed population of elderly residents and younger residents with
disabilities represented a challenge at their developments. During our
visits to housing developments, housing agency officials and building
managers told us that the mixed resident population sometimes led to
tension because residents from each group often lead different
lifestyles. In addition, many of the elderly residents that we
interviewed told us that younger residents were more likely to have
late-night visitors, play loud music, and lead active lifestyles, while
they preferred quieter activities. Resident leaders at one development
we visited told us that some elderly residents did not spend time in
the common areas because they feared younger residents. Another elderly
resident told us that some younger residents in his development robbed
and terrorized the older residents. Further, officials that we
interviewed also said that younger residents with disabilities
sometimes have mental health conditions the housing agencies were not
equipped to address. More specifically, building managers and residents
told us that residents with mental health disabilities often disturbed
other residents if they did not take proper medication.
We found that at 29 of the developments for which we received survey
responses, elderly residents made "very frequent" or "somewhat
frequent" complaints about younger residents with disabilities.
Conversely, at 59 of the developments, younger residents with
disabilities made complaints about elderly residents "a little" or "not
at all."
Extent of Supportive Services:
Thirteen surveyed public housing agency directors mentioned that
providing adequate supportive services was a challenge. Most of the
developments we visited and surveyed had some on-site supportive
services, which assist with activities of daily living and are intended
to help the elderly and persons with disabilities remain independent
and in their communities (see fig. 8).[Footnote 20] However the array
of supportive services varied and often could not be characterized as
meeting the needs of residents. According to a HUD report on housing
needs for the elderly, residents' needs for greater assistance, such as
that offered by a nursing home, may increase as a result of inadequate
supportive services.[Footnote 21] Many of the building managers and
residents that we interviewed told us that residents who moved out of
the public housing development often moved in with family or to a
nursing home because the development lacked sufficient supportive
services. According to data from one public housing agency director, of
21 residents who relocated from one of the public housing developments
during the 2004 calendar year, 6 moved into a nursing home.
Figure 8: Number of Developments with Supportive Services Available On-
Site for Elderly Residents:
[See PDF for image]
Note: The data in this table are for services available to elderly
residents. In most cases, the same services were available for non-
elderly persons with disabilities--although for some, such as
housekeeping assistance and medical or health services, the overall
percent of developments with services available to non-elderly persons
with disabilities was several points lower. For these survey items, we
received responses for 64 developments.
[End of figure]
Although 28 of the developments from which we received survey responses
had some type of on-site medical or health services, these varied from
development to development because not all of the developments with
health services offered assistance with medication. According to
professionals knowledgeable about the housing needs of the elderly and
non-elderly persons with disabilities, having a nurse or healthcare
professional at the development to help residents manage their
medications is beneficial.
The elderly and non-elderly persons with disabilities also often need
assistance with housekeeping, personal care, and meals. One building
manager at a development we visited told us that the residents without
nearby family often needed assistance with housekeeping. During one of
our visits, we observed a resident receiving assistance with
housekeeping. At another development, the housing agency officials told
us that residents appreciated the services from an on-site hair salon.
According to our analysis of our survey data, 34 developments offered
on-site meal preparation services. One building manager at a
development we visited told us that on-site lunch programs were often
the only hot meal of the day for some residents. Building managers at
other developments indicated that many of their residents can no longer
safely cook.
According to our analysis of survey responses, most of the developments
offered recreational activities for the elderly or non-elderly persons
with disabilities. Furthermore, residents we interviewed reported that
recreational activities, such as outings, or organized potluck dinners,
were important to their quality of life. One public housing agency
official with whom we spoke said that many elderly residents do not
have family nearby and without planned activities at the housing
development many would never leave their apartments. According to one
study on public housing for the elderly, up to a third of elderly
residents living in public housing in New York almost never left their
apartments.[Footnote 22] During our visits to 25 housing developments,
we observed on-site activities such as arts and crafts workshops and
sewing and computer classes. Many of the buildings also had libraries,
television rooms, and exercise rooms. According to knowledgeable
professionals, elderly residents need physical activities incorporated
into their daily lives to maintain their health.[Footnote 23] At some
developments we visited, residents said they had events such as bingo
or pancake breakfasts, but lacked activities involving physical
exercise. According to our survey responses, we also found that 25
housing developments offered job training or placement services for
their residents.
Public housing agency directors reported that in 55 of the developments
some kind of scheduled or on-demand door-to-door transportation service
was available. Door-to-door transportation includes vans or buses that
pick up residents at the housing development and take them to
destinations such as grocery stores, banks, or to medical appointments.
However, survey responses from eight developments indicated that
accessing any form of transportation was "not very easy," nor were
grocery stores or other services located near these developments, which
increased the isolation of residents. Several of the residents at the
housing developments that we visited said a lack of accessible
transportation affected their quality of life because they could not
easily get to a grocery store or doctors' appointments.
According to our survey results, 26 housing developments provided
access to a service coordinator at least 20 days per month, while 19
had no service coordinator, and 11 had one available less than 5 days
per month (see fig. 9).[Footnote 24] According to HUD, a service
coordinator assists elderly residents and non-elderly residents with
disabilities of federally assisted housing to obtain needed supportive
services from community agencies, thereby preventing premature and
inappropriate institutionalization. For example, a service coordinator
might find a public housing resident with a disability someone to help
with housekeeping, enabling the resident to remain independent. Service
coordinators also help elderly residents and non-elderly residents with
disabilities determine if they qualify for government services.
According to the 2002 Housing Research Foundation Report cited above,
83 percent of elderly residents in public housing live alone, and
therefore may not have a support network to help them access services
or fill out paperwork. While service coordinators are an important
aspect to improving the quality of life for the elderly and non-elderly
persons with disabilities who reside in public housing, some
developments provided access to service coordinators on a less frequent
basis. For example, one housing agency we visited had one service
coordinator for 2,500 units occupied by elderly persons and non-elderly
persons with disabilities. According to the housing director, this
staffing level was not sufficient to meet resident needs. In another
case, two service coordinators were responsible for all of the housing
agency's 20,000 residents.
Figure 9: Access to a Service Coordinator:
[See PDF for image]
Note: For this survey item, we received responses for 64 developments.
[End of figure]
Crime Near Developments:
Survey data indicated that 38 developments had at least some problems
with crime in surrounding neighborhoods, while 24 developments had at
least some problems with crime inside the development (see fig. 10).
Figure 10: Extent of Crime Problem in and near Developments:
[See PDF for image]
Note: For these survey items, we received responses for 63
developments.
[End of figure]
A few developments that we visited were adjacent to family public
housing developments, which in general--according to our analysis of
HUD data and interviews with housing agency directors--tend to be in
worse condition than public housing occupied by the elderly and non-
elderly persons with disabilities. Housing directors stated that, as a
result, crime was more of a problem at those family-adjacent
developments. Some elderly residents and non-elderly residents with
disabilities told us that they did not feel safe in their neighborhoods
or, sometimes, in their developments. At one housing development, one
resident told us that young people from the neighborhood loitered in
and around their development, which made the elderly residents feel
uncomfortable. At two other housing developments we visited, public
housing agency officials and residents identified tenants who sold
drugs from their apartments, which attracted unwanted outsiders into
the development. Residents at one development said they stopped
participating in recreational activities because they feared someone
would break into their apartments if they left. When problems with
crime and vandalism peaked at another housing development, residents
told us that they formed their own security group to monitor the
activity at the building.
Various Strategies Could Improve Physical and Social Conditions at
Public Housing for the Elderly and Non-Elderly Persons with
Disabilities:
According to officials whom we surveyed and interviewed, various
strategies have been used to improve both physical and social
conditions to better address the special needs of the elderly and non-
elderly persons with disabilities. Methods to deal with physical
distress included capital improvements such as renovating or
modernizing buildings, systems, and units or, in extreme cases,
demolishing or selling a development. Methods to reduce the level of
social distress include a range of actions to address the needs of the
elderly and non-elderly persons with disabilities, such as designating
developments as "elderly only" for reasons of safety, converting
developments into assisted living facilities, and working with other
agencies, such as nonprofit and religious organizations, to provide in-
home supportive services to residents.
Strategies to Improve Physical Conditions:
To improve physical conditions at public housing developments, 18 of
the 43 responding public housing agency directors said they had ongoing
or planned actions, such as modernizing building structures, upgrading
accessibility features, and installing new building systems such as air
conditioning and electrical systems. During our site visits, public
housing agency officials whom we interviewed also described current or
planned renovations to improve the physical conditions of their
developments. For example, at one development the housing agency had
recently improved its lobby and exterior with new paint, tiles, and
landscaping. Building managers at this location told us that these
renovations improved living conditions for residents and made the
development more marketable. The housing agency also converted some of
the first-floor units to be accessible to persons with disabilities and
installed new appliances in the units. Other actions taken by housing
agencies to improve physical conditions include planned or implemented
elevator upgrades, which in some cases have made elevators more
accessible to elderly residents or residents with disabilities. In
addition, at one development we visited that had exterior walkways, the
housing agency was undertaking large-scale renovations, which included
enclosing the exposed areas to protect residents from inclement
weather. At five developments we visited, public housing agencies had
recently added central air-conditioning. Lastly, at three locations we
visited, public housing agencies had previously converted, or planned
to convert, studio apartments into one-bedroom units to better meet the
needs of residents.
Housing agency directors we interviewed during our site visits said
that their housing agencies use public funding from federal, state, and
local sources, and funding from private sources to address physical
conditions. Public housing agency directors whom we surveyed made
similar comments, with 17 citing HUD's Capital Fund as a funding source
to implement building modernizations or to renovate building
components, including actions to accommodate the needs of persons with
disabilities. The Capital Fund provides housing agencies with funds
based on a formula that takes into account the size, location, and age
of developments, along with the need for modernization, among several
other characteristics. Public housing agency directors also reported
using Low-Income Housing Tax Credits to make large-scale improvements
or for new construction.[Footnote 25] Public housing agencies have also
entered into partnerships with private-sector firms to implement a
variety of improvements, such as building upgrades and comprehensive
renovations. According to a housing agency official responsible for
three large housing developments we visited, public housing agencies
often lack development experience; thus, a partnership with private
developers can bring valuable resources to improve public housing
developments.
Public housing agencies also undertook more comprehensive improvement
programs to address difficulties at developments that are associated
not only with physical deterioration, but also with the overall
deterioration of the surrounding neighborhood. For example, in St.
Petersburg, Florida, the housing agency received a $27 million HOPE VI
grant in 1998, which it used to tear down and rebuild all housing at
the Historic Village development and the accompanying family housing
development, Jordan Park. The housing agency made physical improvements
to the development and individual apartments, such as improving
accessibility for persons with disabilities and adding air-
conditioning. Before the redevelopment, Jordan Park had a high
concentration of poverty and a reputation as being a haven for criminal
activity. Building managers told us that the incidence of crime in the
area has since gone down. The HOPE VI grant made up about 40 percent of
the funding necessary for the $70 million improvements at Historic
Village and Jordan Park. Low-Income Housing Tax Credits and a
combination of state and local sources made up the rest of the funding.
According to St. Petersburg housing agency officials, the large-scale
improvements at Historic Village reduced vacancy rates and lowered the
crime rate in the surrounding area, which is one of the goals of the
HOPE VI program.
Figure 11: The Local Housing Agency Completely Rebuilt Historic Village
to Improve Conditions:
[See PDF for image]
[End of figure]
However, at the Graham Park development, the housing agency in St.
Petersburg determined that modifications necessary to improve
accessibility were not feasible or cost effective because widening the
narrow hallways would affect the structural integrity of the building.
As a result, the housing agency submitted an application to sell Graham
Park and use the proceeds to acquire or develop alternative affordable
housing.[Footnote 26] Furthermore, the housing agency will offer
current residents Section 8 housing vouchers so they can rent housing
elsewhere.
Some survey respondents also reported that they were planning to or
were in the process of replacing some of their developments. For
example, eight housing agency directors reported that they were
considering or were implementing actions to demolish or dispose of
existing developments in order to acquire or build new housing for the
elderly and non-elderly persons with disabilities.
Strategies to Improve Social Conditions:
Public housing agency officials we contacted mentioned a variety of
strategies to improve social conditions at housing developments for the
elderly and non-elderly persons with disabilities. For example, 28
housing agency directors who responded to our survey mentioned actions
they have taken or plan to take to address social conditions for
elderly persons and persons with disabilities who reside in public
housing. For instance, 12 housing directors reported that they have
taken actions to resolve problems associated with having elderly and
non-elderly residents in the same development, such as designating
their developments as "elderly only." In particular, a number of
housing directors cited safety concerns caused by young persons with
mental health disabilities. Housing agency directors also reported that
they have added security features and established programs to reduce
crime and increase security. At one development for example, the
housing agency partnered with the local police department to establish
a community watch program. Thirteen survey respondents also reported
taking other actions to address the needs of the elderly and persons
with disabilities, including in-home health and nutrition assistance
and other supportive services. In particular, one public housing
director reported that the housing agency created its own senior
resident advisor, who provides an array of supportive services to
address the needs of its elderly residents.
To improve social conditions on a larger scale, the housing agency in
Allegheny County completely revitalized the Homestead Apartments
outside of Pittsburgh, Pennsylvania.[Footnote 27] The housing agency
built space on-site for two nonprofit elder care service providers in
addition to remodeling the buildings. One provider met the needs of the
frailest residents with complete nursing services, meals, and adult day
care. The other provider operates a walk-in wellness center that
provides Homestead's more independent residents with blood pressure
checks, assistance with medication, and service coordination and
referrals. Housing officials whom we interviewed at Homestead estimated
that the services provided at the adult day care center prevented
nursing home-eligible residents from prematurely entering nursing
homes. This resulted in a monetary savings for the state because,
according to a Pennsylvania Department of Public Welfare director, the
cost of care for those enrolled in the adult day center was only 85
percent of the cost of caring for them at a nursing home. Much of the
new development at Homestead was financed with Low-Income Housing Tax
Credits.
In another large-scale effort, the Miami-Dade Housing Agency converted
Helen Sawyer Plaza into an assisted living facility.[Footnote 28]
Twenty-four hour nursing care, meals, and recreational activities are
now provided on-site. According to the building manager, the conversion
eliminated high vacancy rates at the development, created a sense of
community among the residents, and prevented residents from prematurely
entering nursing homes. The housing agency uses Medicaid Home and
Community-Based Services waivers to obtain federal funding for the
assisted-living care of residents at Helen Sawyer. Such Medicaid
waivers offer states the flexibility to pay for nursing services
delivered outside of institutional settings.[Footnote 29] In addition,
officials we interviewed at Helen Sawyer asserted that conversions to
assisted living facilities are cost-effective options, in part, because
public housing agencies own the property on which the public housing is
built. As a result, housing agencies do not have to assume the mortgage
or lease payments that comparable private assisted living facilities
often have.
Based on our survey results and information from housing officials whom
we interviewed, housing agencies partnered with outside agencies, such
as community-based nonprofits or churches, to provide supportive
services for the elderly and non-elderly persons with disabilities. In
some cases, the agencies paid for the services; but in some cases,
housing agencies also used federal grants.[Footnote 30] A building
manager for one development that we visited said they partnered with a
nearby church to provide a van to take residents shopping once a week.
Local churches also provided food assistance to elderly residents and
residents with disabilities who were not able to leave their apartments
at this development. At another housing development we visited in
Miami, Florida, Catholic Charities, a community-based organization,
provided lunches on a daily basis to residents and assorted grocery
items such as bread, fruit, and cereal on a weekly basis. We also
observed a partnership in Seattle, Washington, where the housing agency
partnered with a community-based organization to provide an on-site
elderly community center where residents had access to meals, social
activities, and assistance with filling prescriptions. Residents at
this development also had access to an on-site health clinic. In
addition, based on responses to our survey, five housing agency
directors cited HUD's Resident Opportunities and Self Sufficiency
(ROSS) grant program as a means to provide supportive services such as
assistance with health, activities of daily living, and
transportation.[Footnote 31] Finally, public housing officials at two
locations we visited also reported that ROSS grants funded door-to-door
transportation for residents, assistance with housekeeping, and service
coordinators, among other services.
Observations:
The extent to which public housing developments for the elderly and non-
elderly persons with disabilities is severely distressed cannot be
determined definitively with existing data, which are insufficient
regarding factors that contribute to distress. Moreover, much of the
data that are available are at the development level, rather than the
individual building or unit level. These limited data, along with
information from housing agency directors, suggest that severe distress
in public housing developments primarily occupied by elderly residents
and residents with disabilities was less prevalent than in developments
occupied primarily by other types of residents. However, our work
indicates that a number of developments primarily occupied by the
elderly and non-elderly persons with disabilities are physically and/or
socially distressed. Further, our site visits and survey of selected
public housing directors indicate that, even in developments that may
not be considered distressed, a number of physical and social factors
can negatively affect the quality of life for public housing residents
who are elderly or have disabilities.
The directors' agencies have implemented several strategies to address
a variety of factors that contribute to problematic conditions for both
elderly and non-elderly residents with disabilities, such as improving
accessibility to persons with disabilities, addressing problems
associated with mixing elderly and non-elderly disabled persons, and
undertaking larger scale efforts to provide supportive services.
Nevertheless, our work indicated that a significant number of the 66
developments covered by our survey will need replacement, renovation,
or rehabilitation in the future and that the array of supportive
services has often not met the needs of residents. These findings
suggest that continued efforts will be needed to improve the quality of
life for residents who are elderly, increasingly frail, or have
disabilities.
Agency Comments:
We provided a draft of this report to HUD for its review and comment.
We received oral comments from officials in HUD's Office of Public and
Indian Housing indicating general agreement with the report. As a
general comment, one official stated that the draft report underrates
the adverse impact of the lack of accessibility of units for persons
with disabilities. The official also noted that as elderly residents
continue to age in place, their accessibility needs will increase. We
did not attempt to determine a correlation between the extent of
accessibility in public housing units and the percent of residents with
disabilities. However, our report notes that public housing residents
who are elderly or have disabilities may have more special needs,
compared with other residents, due to their age and type of disability
and that elderly public housing residents are more likely to be "frail"
or to have disabilities, compared with other elderly persons. HUD also
suggested that the report should contain additional discussion on how
public housing agencies use HOPE VI funds to provide supportive
services to the elderly. We did not insert additional information
because in this report, as well as previous reports cited herein, we
have provided information on the use of HOPE VI as a funding source for
community and supportive services. Finally, one official expressed
agreement with the public housing directors who, in responding to our
survey, indicated that one method of reducing social distress is
working with governmental and nonprofit organizations to provide
supportive services. HUD also provided technical clarifications, which
we incorporated as appropriate.
We are sending copies of this report to the HUD Secretary and other
interested congressional members and committees. We will make copies
available to others upon request. In addition, this report will also be
available at no charge on our Web site at , If you or your staff have
questions about this report, please contact me at (202) 512-8678 or
[Hyperlink, Woodd@gao.gov]. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last
page of this report. Key contributors to this report are listed in
appendix IV.
Signed by:
David G. Wood:
Director, Financial Markets and Community Investment:
[End of section]
Appendixes:
Appendix I: Objectives, Scope, and Methodology:
The objectives of this report were to examine (1) the extent to which
public housing developments occupied primarily by the elderly and non-
elderly persons with disabilities were severely distressed and (2) the
ways in which the stock of severely distressed public housing for the
elderly and non-elderly persons with disabilities could be improved.
We analyzed tenant and development characteristic data from the
Department of Housing and Urban Development's (HUD) Public and Indian
Housing Information Center (PIC) database and physical inspection data
from the Real Estate Assessment Center (REAC) database. We obtained
data from HUD in January 2005 for both databases. For purposes of this
report, we sought to use PIC data to describe the number of households
headed by elderly persons or persons with disabilities and to identify
developments occupied primarily by elderly persons or persons with
disabilities that were potentially severely distressed. To assess the
reliability of data from the PIC database, we reviewed relevant
documentation, interviewed agency officials, including contractors who
worked with these databases, and conducted electronic testing of the
data, including frequency and distribution analyses. Our assessment
showed that some tenant and development characteristic data for the 28
housing agencies that are Moving to Work (MTW) sites were outdated by
as many as 6 years because, at the time of our data collection, HUD had
not yet implemented a system that allowed PIC to accept MTW
data.[Footnote 32] For the purposes of this report, we sought to
identify developments that were potentially distressed; therefore, we
determined these data to be sufficiently reliable for use in our first
index. However, for the developments that we surveyed, we asked housing
agencies to verify data for the six fields we used from PIC to identify
developments that were potentially distressed. When we compared the
updated data that were received through our survey to the data
contained in PIC, we found that 39 of 62 developments had decreased
vacancy rates, compared with the PIC data, while 8 had increased
vacancy rates. In a few cases, we found that developments that had been
demolished were reported in the PIC system as existing developments.
Similarly, we found a few instances where developments had been
approved for sale but remained in the PIC system as part of a public
housing agency's current housing portfolio.
To assess the reliability of the data from the REAC database and the
adjusted REAC data from the Urban Institute, we reviewed relevant
documentation, interviewed knowledgeable officials, including
contractors who worked with the database, and conducted electronic
testing of the data, including frequency and distribution analyses. We
determined the data to be sufficiently reliable to identify
developments that were potentially distressed. However, we also asked
housing agency directors to verify their physical inspection score that
we obtained from REAC. We compared the updated data received through
our survey with the data contained in REAC and found that in 6 of 62
cases, the two data points differed by more than 15 percent. A possible
reason for these discrepancies is that REAC scores can be volatile
based on the nature of the problems identified in the rating. For
example, an updated REAC score that was markedly better than the
previous one could have resulted from the remedying of easily fixable
items. Had HUD possessed current PIC and REAC data on all developments,
our first index may have identified some developments that were
different from those identified in this report; this was the reason
that we sought corroboration on these data through survey questions. We
have noted these limitations in our report when appropriate.
We focused our analysis on housing "developments" because much of the
available data were at the development rather than the individual
building or unit level. (A development can be a collection of
buildings, located near each other or scattered geographically, or an
individual building.) As a result, our analysis does not necessarily
include all public housing units that are occupied by elderly persons
or non-elderly persons with disabilities, because such units may be
located in developments that are occupied primarily by other types of
residents.
To determine criteria for defining public housing as primarily occupied
by elderly persons and non-elderly persons with disabilities, we
consulted with officials from HUD and reviewed relevant studies. We
decided to identify public housing developments as primarily those
occupied by elderly persons or non-elderly persons with disabilities if
they met the following criteria:
* There were at least 10 occupied units in the development; and:
* 50 percent of head of households were elderly persons (aged 62 or
older); or 50 percent of head of households were non-elderly persons
with disabilities; or 80 percent of head of households were either
elderly persons or non-elderly persons with disabilities.
Based on our analysis of PIC data, we categorized public housing
developments as either (1) developments occupied primarily by elderly
persons or non-elderly persons with disabilities if they met the above
criteria, (2) family developments if they did not meet the above
conditions, and (3) developments that were mostly family housing but
contained buildings with a concentration of elderly persons or persons
with disabilities.
To determine the criteria for a severely distressed development
occupied primarily by elderly persons and non-elderly persons with
disabilities, we interviewed HUD officials, knowledgeable individuals
from social research organizations, and reviewed relevant laws and
literature. To determine if HUD's developments occupied by elderly
persons or non-elderly persons with disabilities were severely
distressed, we identified eight indicators of severe distress from the
PIC and REAC systems and data from other sources. For each development
we used (1) physical inspection score; (2) adjusted physical inspection
score provided by the Urban Institute; (3) building age; (4) percent of
units deemed accessible to persons with disabilities; (5) vacancy rate;
(6) household income; (7) percent of population in census tract below
poverty line; and (8) status of the development regarding application
for HOPE VI funding or approval for demolition, disposition, or
revitalization. For the "adjusted physical inspection score," the Urban
Institute edited HUD's REAC physical inspection scores to avoid heavily
penalizing developments for deficiencies that were easily correctable.
For example, HUD deducts many points for inoperable smoke detectors, a
serious but easily fixable problem. The Urban Institute deducted fewer
points for these defects, so the "adjusted score" puts more weight on
the soundness of the physical structures.
Although we used the eight indicators to identify potentially severely
distressed developments, these indicators had some limitations. For
example, we used a high vacancy rate as one indicator of severe
distress. However, in some instances, a development had a high vacancy
rate because some of the units were being taken out of the available
housing stock for purposes such as redesign, but still were categorized
in HUD's database as available. Moreover, we used the age of the
building as an indicator of physical distress. However, in some cases,
we found that housing developments recently had undergone renovation.
In these cases, building age was not a good indicator of physical
distress.
For each development, we obtained data for each of the eight indicators
of severe distress. We then examined the distributions of the data for
each of the eight indicators, and scaled each indicator from 0 to 10.
We then calculated a composite score for each development by computing
an average for each development from their scores on the eight
indicators. Based on the distribution of the composite scores, and
judgment as to what constituted distress, we established a threshold
score to indicate potential severe distress and potential moderate
distress. We eliminated from the scoring developments that were missing
data from three or more of the indicators.
From our analysis, we found a total of 11,935 developments in the 50
states and the District of Columbia that had at least 10 occupied units
and data available on at least six of the eight indicators of distress.
We determined that 3,537 of these developments met our criteria as
"primarily occupied by elderly persons or non-elderly persons with
disabilities." Of these 3,537 developments, we identified 76
developments (administered by 46 public housing agencies) that were
potentially severely distressed. We conducted site visits to 25 of
these developments, interviewed building managers, resident leaders,
and local public housing agency officials, and observed the physical
and social conditions at the sites. We selected housing agencies to
visit based on factors such as diversity of size, geographic location,
and number of potentially distressed developments.
We then surveyed the 46 public housing agencies that manage the 76
potentially severely distressed developments to collect data describing
their physical and social conditions. In developing the survey
questions, we utilized our literature review on distressed public
housing and the special needs of the elderly and non-elderly persons
with disabilities, conducted interviews with representatives of
advocacy organizations and professional associations interested in
issues affecting the elderly and non-elderly persons with disabilities,
and reviewed our field work conducted at several public housing
developments. Through this research, we identified supportive services
and housing features that are needs of the elderly and non-elderly
persons with disabilities that reside in public housing and structured
survey questions, accordingly. HUD staff located in the Office of
Public and Indian Housing and the Office of Policy Programs and
Legislative Initiatives reviewed the survey questionnaire and provided
comments. Knowledgeable individuals from the National Association of
Housing and Redevelopment Officials and the American Association of
Service Coordinators also provided feedback on the survey. We pretested
the survey with the directors of six housing agencies located in
California, Connecticut, Hawaii, New Jersey, and Indiana. Lastly, four
independent social scientists reviewed the survey for soundness.
We mailed the survey (questionnaire) to each public housing agency on
June 10, 2005. In the survey, we asked the local housing agency to
verify, update, or correct the data we obtained from HUD on percent of
units that were occupied by elderly persons or non-elderly persons with
disabilities and data on five of our eight indicators of distress.
Questions covered the following topics: physical deterioration, systems
requiring renovation or modernization, the neighborhood environment in
which the development was located, accessibility features, access to
social and public services, and actions to remedy housing challenges
(see [Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-205SP] for a
copy of the survey). Each questionnaire contained a set of specific
questions about the identified development and a set of general
questions about public housing for the elderly and non-elderly persons
with disabilities. In the 11 cases where the housing agency managed
more than one of the identified 76 developments, respondents were asked
to provide separate answers--in response to the specific questions--for
each of the identified developments. For the 35 public housing agencies
with one development, we also asked the local housing agencies whether
they had other developments or buildings occupied primarily by elderly
persons or non-elderly persons with disabilities that did not score
above our distress threshold, but had conditions comparable to or worse
than the developments we identified. In a few cases, public housing
agencies indicated that they did have other developments comparable or
worse than the ones we identified. This indicates that the eight
indicators we used to identify potentially distressed developments did
not always capture cases of potential distress in developments occupied
primarily by elderly persons or non-elderly persons with disabilities.
Participants could return the questionnaire by mail or fax. To increase
the response rate, we conducted three sets of follow-up telephone calls
to offices that had not responded to our survey by the initial
deadline. Collection of survey data ended on August 30, 2005. We had 43
housing agencies return the survey, providing a response rate of 93
percent, and representing 66 of the 76 developments. We did not attempt
to verify the respondents' answers against an independent source of
information; however, we used two techniques to verify the reliability
of questionnaire items. First, we used in-depth cognitive interviewing
techniques to evaluate the answers of pretest participants.
Interviewers judged that all the respondents' answers to the questions
were correct. Second, we compared some responses with observations made
during site visits; again, observers concluded that responses to these
items were correct.
The practical difficulties of conducting any survey may introduce
certain types of errors, commonly referred to as nonsampling errors.
For example, differences in how a particular question is interpreted,
the sources of information available to respondents, or the types of
people who do not respond can introduce unwanted variability into the
survey results. Steps such as pretesting and follow-up contacts to
increase response rates serve to minimize nonsampling errors. In
addition, to further reduce errors, we performed statistical analyses
to identify inconsistencies and used a second independent reviewer for
the data analysis. We edited for consistency before the data were
entered into an electronic database. All survey data were 100-percent
verified, and a random sample of the surveys was further verified for
completeness and accuracy. We analyzed responses to close-ended
questions using statistical software. One analyst reviewed and
categorized responses to open-ended questions, which was then
independently verified by a second trained analyst. Because the
developments selected for our survey were not based on a random sample,
the results are not generalizable to all public housing for the elderly
and non-elderly persons with disabilities. To identify the developments
with the greatest indications of severe social or physical distress
based on survey responses we developed "distress indexes." See appendix
II for more detail.
To examine the ways in which the stock of severely distressed public
housing for the elderly and non-elderly persons with disabilities could
be improved, we reviewed relevant laws and regulations, and reports by
federal agencies and research organizations. We also interviewed
residents of public housing and public housing agency directors. We
analyzed the interview responses and developed a summary of the most
frequently reported strategies. Finally, we included questions in our
survey to the public housing agency directors that operate the 76
developments that we identified as potentially severely distressed. We
analyzed the responses from the survey and developed a summary of the
most frequently reported strategies (see [Hyperlink,
http://www.gao.gov/cgi-bin/getrpt?GAO-06-205SP] for a copy of the
survey and aggregated results).
We conducted our work in Washington, D.C; Miami and St. Petersburg,
Florida; Homestead, New Castle, and Pittsburgh, Pennsylvania;
Evansville, Indiana; St. Louis, Missouri; Seattle, Washington; and
Oakland and San Francisco, California, between November 2004 and
October 2005 in accordance with generally accepted government auditing
standards.
[End of section]
Appendix II: Technical Methodology:
To identify the developments with the greatest indications of severe
social or physical distress based on survey responses, we developed
"distress indexes." To create the indexes, we assigned points to
individual survey questions based on their level of importance and
impact on the quality of life for the elderly and non-elderly persons
with disabilities. We used evidence from interviews with individuals
knowledgeable of the housing needs of the elderly and non-elderly
persons with disabilities to determine how to weight the questions. The
nature of some topics, and thus the number of items about that topic,
reflect the relative importance of that topic in determining distress.
For example, we asked nine questions about which supportive services
are available to residents, reflecting how significantly supportive
services can affect conditions for residents of public housing.
We assigned points to survey response items that indicated conditions
of physical or social distress, giving higher points to responses that
indicated more distress and no points to responses that indicated
little distress. For example, one of the survey questions asked about
the extent to which the physical structures at the development were
deteriorated. We assigned 20 points to the physical distress index
score if the respondent answered, "extremely deteriorated," 15 points
if the answer was "very deteriorated," 10 points if "somewhat
deteriorated," 5 points if "a little deteriorated," and no points if
the answer was "not at all deteriorated."
We then summed the points for all questions for each development, which
resulted in overall physical and social distress index scores. Each
development could score up to 139 points on the physical distress index
and up to 205 points on the social distress index. We analyzed the
results for each of the 66 developments for which we had survey
responses to determine the total scores for both physical and social
distress. We determined that developments that had a score of 50
percent or more of the total points for either index had signs of
severe physical or severe social distress. We were able to verify that
a score of 50 percent or more indicated severe distress because we
visited some of these developments and made detailed observations on
their condition. See table 1 for the specific points assigned to each
indicator of physical and social distress.
Table 1: Point System and Indicators Used in Our Distress Index:
Physical distress score:
How deteriorated is the building;
Points: 20.
Various systems in need of renovation;
Points: 42.
Accessibility issues for persons with disabilities;
Points: 32.
Physical reasons for vacancies;
Points: 20.
Estimated repair cost per unit;
Points: 10.
Secure entrance;
Points: 5.
How well lit;
Points: 5.
Mold;
Points: 5.
Total points: 139.
Social distress score:
Various services provided on-site;
Points: 60.
Services available nearby;
Points: 35.
Availability of a service coordinator;
Points: 20.
Access to transportation;
Points: 20.
Crime indicators;
Points: 30.
Graffiti;
Points: 10.
Vacant homes/businesses nearby;
Points: 10.
Complaints about other residents;
Points: 20.
Total points: 205
Source: GAO.
[End of table]
[End of section]
Appendix III: Description of Site Visits to Two of HUD's Innovative
Models in Public Housing for the Elderly:
We visited both the Homestead Apartments and Helen Sawyer Plaza
developments and interviewed public housing agency officials and
building managers. We also interviewed residents at the Homestead
Apartments. The following describes in more detail the approaches used
by the housing agencies to provide housing and services to its elderly
residents at these developments.
Homestead Apartments:
Housing Agency Actions:
Allegheny County housing agency officials successfully renovated the
Homestead Apartments near Pittsburgh, Pennsylvania, and made
improvements to provide supportive services. The housing agency chose
to renovate the Homestead Apartments because of the high concentration
of elderly residents and because two of Homestead's high-rise buildings
were the oldest buildings in the housing agency's portfolio. To
renovate the apartments at Homestead, the housing agency partnered with
a private real estate development firm that specialized in residential
housing and community development. The interior portions of each of the
development's four high-rise buildings were replaced, and the housing
agency added or built updated features. As part of the renovation, the
housing agency converted 350 units into 240 apartments, with two-
bedroom apartments and lounges added to every floor. Previously, the
apartments were exceptionally small and had kitchen and bath
configurations that would not accommodate persons with disabilities.
Further, the housing agency reconfigured 5 percent of the units, and
all of the laundry areas and lounges, to be accessible to persons with
disabilities. To improve common areas of the development, the housing
agency also installed large windows in the hallways to increase levels
of natural light.
A primary goal of the Homestead revitalization was to provide enhanced
supportive services to elderly residents, in particular frail elderly
residents. The housing agency in Allegheny County surveyed Homestead
residents to determine how best to provide services and based on their
responses, developed three categories according to the level of care
they needed. The first group included the "most frail" residents, who
had medical or functional frailties. The second group consisted of "at-
risk" residents, who may have needed occasional services. The third
group was made up of residents who were healthy and rarely used any of
the available services. According to the health care staff at these
facilities, residents typically progress through these three stages as
they age.
The housing agency then partnered with several non-HUD entities to
improve services for the elderly and colocate an assisted living type
of facility at the development. To help the most frail elderly
residents, the housing agency partnered with a nonprofit organization-
-Community LIFE (Living Independently for Elders)--which offers
complete nursing services, meals, and physical therapy (see fig. 13) to
Homestead residents who are enrolled in the program. The LIFE Center
also has a beauty salon that enrollees can use once a month for free.
These services are modeled after the Program of All-Inclusive Care for
the Elderly (PACE).[Footnote 33] For most participants, these
comprehensive services permit them to continue living at home.
Homestead residents represent about 40 percent of the LIFE Center's
enrollees.
Figure 12: Physical Therapy Area at the Community LIFE Center:
[See PDF for image]
[End of figure]
For at-risk residents, who do not require the level of care provided at
the LIFE Center, the housing agency partnered with the University of
Pittsburgh Medical Center (UPMC) to provide on-site services in the
form of a walk-in wellness center. The services include blood pressure
checks, glucose tests, assistance with medication, social service
coordination, and space for visiting physicians. The UPMC facility also
had two registered nurses on staff. All Homestead residents are free to
take advantage of the services offered at the UPMC facility, which is
colocated at the development and easily accessible to residents. UPMC
also operates an exercise room in the Homestead Apartments, which has
become popular among residents.
Funding:
According to the housing agency officials at Allegheny County, the
renovation and colocation of supportive services were made possible by
an innovative coordination of efforts and use of mixed financing.
Approximately 67 percent of the funding for the Homestead renovation
was based on Low-Income Housing Tax Credits. Under this program, states
are authorized to allocate federal tax credits as an incentive to the
private sector to develop rental housing for low-income households.
After the state allocates tax credits to developers, the developers
typically offer the credits to private investors, who use the tax
credits to offset taxes otherwise owed on their tax returns. Other
funding sources included state and local grants, a federal loan, and a
$2.5 million dollar HOPE VI grant. According to the Allegheny County
officials, the award of the HOPE VI grant helped to ensure potential
investors that the project was viable. In addition, the LIFE Center was
developed during renovation, thereby facilitating the colocation of
this supportive service. To maintain the LIFE Center over the long-
term, the housing agency was able to offer an attractive low-cost lease
to Community LIFE because the agency already owned the land on which
the facility was built. In addition, residents who are enrolled in the
LIFE Center are eligible for Medicare or Medicaid, so Community LIFE
receives payment through those programs. Proceeds from the LIFE
Center's lease with the housing agency are used to fund UPMC services.
Helen Sawyer Plaza:
Housing Agency Actions:
The Miami-Dade Housing Agency converted Helen Sawyer Plaza into an
assisted living facility to enable elderly residents to "age in place"
and avoid often costly institutional alternatives such as nursing
homes. According to officials at Helen Sawyer, prior to conversion, the
facility suffered from a high vacancy rate, and some of the building
systems were outdated. Helen Sawyer residents now receive a variety of
supportive services, which were made available as part of the assisted
living conversion. For example, residents receive 24-hour nursing care
and three hot meals per day in the dining room. A hairdresser and
manicurist visit the development twice weekly. The development offers
30 hours of activities weekly, including aerobics, dancing, cultural
events, and arts and crafts. Residents also have access to door-to-door
transportation and a weekly shuttle for grocery shopping. Staff on-site
offer or coordinate other supportive services such as podiatry,
assistance with taking prescribed medications, and adult day care. An
additional benefit of the conversion is that married residents can
continue to live together in their apartments, even when one spouse
requires assisted living care.
To improve physical conditions at the eight-story Helen Sawyer Plaza,
the building was modernized and apartments were made more spacious,
which made the development more attractive to elderly residents. The
development now has 104 apartments, including 83 studio apartments and
21 one-bedroom apartments. The studio units are 450 square feet while
the one-bedroom units are 600 square feet. Security features at the
development include perimeter iron fencing with card-access entry and
individual emergency alarm systems for each apartment. Amenities now
include a lobby, public restrooms, commercial kitchen, resident dining
room, and community room. The housing agency also added grab bars
throughout common areas and made improvements to more easily
accommodate wheelchairs or motorized scooters.
Figure 13: Commercial Kitchen Space at Helen Sawyer Plaza:
[See PDF for image]
[End of figure]
Funding:
Helen Sawyer Plaza's conversion into an assisted living facility was a
multiphase process that required coordination among several
organizations. For example, the housing agency contracted with a
consultant who had expertise on assisted living facilities, obtained
HUD modernization funding, and borrowed money to rehabilitate the
building, obtained a license from the State of Florida to operate as an
assisted living facility, and petitioned the Florida Department of
Elderly Affairs for a Medicaid Home and Community-Based Services
waiver.[Footnote 34] The waiver essentially allows the housing agency
to receive money from the state to cover the cost of caring for
residents at Helen Sawyer. The Miami-Dade officials also pointed out
that funding from Medicaid waivers can be an incentive to convert a
public housing development to an assisted living facility. For example,
65 Helen Sawyer Plaza residents receive Medicaid waivers that reimburse
up to $28 per day for services. The Miami-Dade Housing Agency also
coordinated with the city of Miami and Dade County to revitalize
abandoned buildings in the neighborhood and offer transportation
service at Helen Sawyer Plaza.
[End of section]
Appendix IV: GAO Contact and Staff Acknowledgments:
GAO Contact:
David G. Wood, (202) 512-8678 or [Hyperlink, woodd@gao.gov]
Staff Acknowledgments:
In addition to the contact named above, Paul Schmidt, Assistant
Director; Isidro Gomez; Robert Marek; Alison Martin; Marc Molino; Don
Porteous; Linda Rego; Barbara Roesmann; and Michelle Zapata made key
contributions to this report.
(250206):
FOOTNOTES
[1] The Development Reform Act of 1989, Pub. L. No. 101-235, title V,
103 Stat. 1987, 2048 (Dec. 15, 1989), established the National
Commission on Severely Distressed Public Housing, which was charged
with (1) identifying severely distressed public housing projects, (2)
assessing strategies used to improve the condition of severely
distressed public housing projects, and (3) developing a national
action plan for eradicating severely distressed public housing by the
year 2000.
[2] Departments of Veterans Affairs and Housing and Urban Development
and Independent Agencies Appropriations Act, 1993, Pub. L. No. 102-389,
title II, 106 Stat. 1571 (Oct. 6, 1992).
[3] See 42 U.S.C. § 1437v(j)(2)(A)(iii)(III).
[4] Pub. L. No. 108-186, title IV, 117 Stat. 2693 (Dec. 16, 2003).
[5] We do not have current information on the potential impacts of
Hurricane Katrina on public housing developments that were within the
scope of our review, including developments located in New Orleans,
Louisiana and Mobile, Alabama.
[6] United States Housing Act of 1937 (Low-Rent Housing Act) (Wagner-
Steagall Housing Act), ch. 896, 50 Stat. 888 (Sept. 1, 1937). For
purposes of low-income housing, HUD defines "elderly" as a person aged
62 or older, and a "person with disabilities" as a person who (1) has a
disability as defined in 42 U.S.C. § 423; (2) has a physical, mental,
or emotional impairment expected to be of long, continued, and
indefinite duration that impedes the individual's ability to live
independently, which is of the nature that independence could be
improved by more suitable housing conditions; or (3) has a
developmental disability as defined in 42 U.S.C. § 15002(8)(A). 42
U.S.C. § 1437a(b)(3)(D) and (E); and 24 C.F.R. §§ 5.100, 5.403, and
5.603. The term "disability" is further defined as the inability to do
any substantial gainful activity because of a physical or mental
impairment that will result in death or has lasted or will last for a
continuous period of 12 months or more. 42 U.S.C. § 423(d)(1). The term
"developmental disability" is further defined to mean a severe, chronic
disability that is attributable to a mental or physical impairment or
combination thereof; is manifested before 22 years of age; likely will
continue indefinitely; results in substantial functional limitations in
three or more major life activities; and reflects the person's need for
individualized special services, supports, or other forms of lifelong
assistance. 42 U.S.C. § 15002(8)(A). See appendix I for the criteria we
used for categorizing developments as occupied by "primarily elderly
and non-elderly persons with disabilities."
[7] The Public Housing Capital Fund provides funds, annually, to public
housing agencies for the development, financing, and modernization of
public housing developments and for management improvements. 42 U.S.C.
§ 1437g(d). The funds may not be used for luxury improvements, direct
social services, costs funded by other HUD programs, and ineligible
activities as determined by HUD on a case-by-case basis.
[8] GAO, Public Housing: HOPE VI Leveraging Has Increased, but HUD Has
Not Met Annual Reporting Requirement, GAO-03-91 (Washington, D.C. Nov.
15, 2002).
[9] Section 1915(c) of the Social Security Act, codified at 42 U.S.C. §
1396n(c), authorizes the Secretary of Health and Human Services to, by
waiver, provide Medicaid reimbursement for home or community-based
services (other than room and board) where, but for the provision of
such services, the individuals would require treatment in a nursing
facility or an intermediate care facility for the mentally retarded,
the cost of which could be reimbursed under the state Medicaid plan.
[10] Housing Research Foundation, Public Housing for Seniors
(Washington, D.C. 2002).
[11] In this context "families" refers to households consisting of
residents other than the elderly or persons with disabilities.
[12] The PIC "Housing Authority" sub-module maintains descriptive
information about the developments and units under management of public
housing agencies, while the "Form HUD-50058" sub-module collects,
stores, and generates reports on families who participate in Public
Housing, Indian Housing, or Section 8 rental subsidy program.
[13] We have reported on HUD's systems for overseeing properties in the
public housing program. See GAO, Public Housing: New Assessment System
Holds Potential for Evaluating Performance, GAO-02-282 (Washington,
D.C. Mar. 15, 2002).
[14] HUD-certified REAC inspectors annually inspect a random sample of
the units to assess the housing agencies' performance in maintaining
their properties, and assign a score.
[15] The Urban Institute is a nonpartisan economic and social policy
research organization. In addition to HUD physical inspection results,
we used the Urban Institute's adjusted data because the methodology the
researchers employed put more weight on the soundness of the physical
structures. See also appendix 1.
[16] See appendix I for additional information on the methods we used
to develop the index of distress and on limitations of the data.
[17] Our results are based on a total of 11,935 public housing
developments in the 50 states plus the District of Columbia with at
least 10 occupied units and with data available on at least five
indicators of distress. See appendix I for the criteria we used for
categorizing developments as "mainly occupied by the elderly or non-
elderly persons with disabilities," "mainly occupied by families," or
"family housing developments with concentrations of elderly persons or
persons with disabilities."
[18] According to the definition of "accessible units" in 24 C.F.R. §
945.105.
[19] HUD designates a public housing agency with a physical inspection
score less than 60 percent as "troubled performer."
[20] We recently reported and testified on the availability of
supportive services at HUD-assisted properties housing the elderly,
including public housing. See GAO, Elderly Housing: Federal Housing
Programs That Offer Assistance for the Elderly, GAO-05-174 (Washington,
D.C. Feb. 14, 2005); and Elderly Housing: Federal Housing Programs and
Supportive Services, GAO-05-795T (Washington, D.C. June 16, 2005).
[21] HUD, Housing our Elders (Washington, D.C. 1999).
[22] Housing Research Foundation, Public Housing for Seniors
(Washington, D.C. 2002).
[23] American Family Physician, Promoting and Prescribing Exercise for
the Elderly (2002).
[24] According to our survey responses, of the 45 developments with at
least a part-time service coordinator, 29 were HUD-funded, 12 were not
HUD-funded, and 4 did not specify.
[25] Under the Low-Income Housing Tax Credit program, federal tax
credits are used as an incentive to the private sector to develop
rental housing for low-income households.
[26] Section 18 of the Housing Act of 1937 (the Act), as amended,
authorizes the demolition and disposition of public housing. 42 U.S.C.
§ 1437p. HUD promulgated its regulations in 24 C.F.R. Part 970, which
details the administrative steps required to perform
demolition/disposition activity in accordance with the Act. Valid
reasons for disposition or demolition include (1) prohibitive costs to
bring existing developments into compliance with current standards; (2)
locations no longer conducive to residential use; (3) high land values
that would allow public housing agencies to replace existing
developments with improved developments at no cost to HUD; (4)
demolition or disposition of a portion of the development will allow
the remaining portions of the development to be renovated, or (5) that
leasing of the development to another party would be more cost-
effective or efficient.
[27] The Homestead Apartments, one of HUD's eleven "Innovative Models
in Elderly Public Housing," were developed for the frail elderly. One
of the goals of HUD's innovative models initiative is to determine the
special needs of elderly public housing residents and how to maximize
service dollars from non-HUD entities using HUD housing resources. See
appendix III for more information on the innovative Homestead
Apartments.
[28] Similar to the Homestead Apartments, Helen Sawyer Plaza is one of
HUD's eleven "Innovative Models in Elderly Public Housing," where
comprehensive improvements were made to better address the needs of
frail elderly residents. See appendix III for more information on the
innovative Helen Sawyer Plaza.
[29] The conversion of public housing into assisted living facilities
is not feasible in states that do not obtain Medicaid Home and
Community-Based Services waivers unless other sources of funding are
identified.
[30] For more information on federal housing programs that assist the
elderly and persons with disabilities, including those that provide
supportive services, see GAO, Elderly Housing: Federal Housing Programs
That Offer Assistance for the Elderly, GAO-05-174 (Washington, D.C.
Feb. 14, 2005).
[31] The ROSS grant program helps fund service coordinators and helps
link residents with appropriate services.
[32] MTW is a HUD demonstration program that was authorized under the
Omnibus Consolidated Rescissions and Appropriations Act of 1996 (Pub.
L. No. 104-134, 110 Stat. 1321 (Apr. 26, 1996)). The program offers
public housing agencies the opportunity to design and test self-
sufficiency strategies for low-income families by allowing exemptions
from existing public housing and tenant-based Housing Choice Voucher
rules and permitting housing agencies to combine operating, capital,
and tenant-based assistance funds into a single agencywide funding
source, as approved by HUD.
[33] PACE is a program through the Center for Medicaid and Medicare
Services. PACE is a managed care benefit for the frail elderly provided
by a not-for-profit or public entity that features a comprehensive
medical and social service delivery system. It uses a multidisciplinary
team approach in an adult day health center supplemented by in-home and
referral service in accordance with participants' needs.
[34] Section 1915(c) of the Social Security Act, codified at 42 U.S.C.
§ 1396n(c), authorizes the Secretary of Health and Human Services to,
by waiver, provide Medicaid reimbursement for home or community-based
services (other than room and board) where, but for the provision of
such services, the individuals would require treatment in a nursing
facility or an intermediate care facility for the mentally retarded,
the cost of which could be reimbursed under the state Medicaid plan.
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