house design for elderly

i'm going to turn it over moderator. >> i like that, no fanfare. good afternoon, every one. okay, i'll try that again. good afternoon, every one! okay, i like that, thank you very mu afternoon to moderate it because

i'm here to learn. i'm very concerned about where we are in america as it relates to as someone who has bought property in south florida community, it not discernible who is one of my there and i'm curious about

doing that so i've begun to do efforts to seat who is related to me, brothers and sisters by different mothers, if you without introduce members of the panel. nancy, because i think people in the back can't see your card, nancy.

nancy is professor of law political and civil rights and tax ation. she has lectured on same sex relationships and lgbt aging. and elderly law that has practical proposals for reform. our next pan list is ken johnson, graduate of harvard law

u.s. department of health and human services, civil rights office. he supervise a team of civil rights analyst who focuses on health disparities, fiscal accessibili discrimination of aids treatsment and services as well

as other programs. he previously served nine years as a senior trial attorney in the department of justice civil rights division eric is a did easting attorney for the nation -- directing attorney for the national civil rights center.

he special eyeses in nursing support. he co-council litigation on behalf of consumers and is the author of law term advocacy and consumer guide, 20 common nursing home problems and how t resolve them. gina, an expert in hiv/aids

housing has led her agency, she is a vocal advocate for people she is the founder and board member of the national aids housing coalition since 1993 and a steering committee member of the new 30 for 30 campaign which positive women. gina would like to have you also

know she is soon to be 59 and is looking forward for you all to of her and her elder friends. laurie cook and has been an active -- has been active in decades. in 1998 she founded at trans aging network, now a partner in the center for lgbt aging.

she is currently policy director for a organization in milwaukee. last is hillary mayer, this the aoa funded director of nawnsal resource center and project officer visions, lgbt elders known as sage. prior to her work there she was

the fair courts she received her jd from rutgers law school. that's our panel. >> thank you very much, christopher, and i would just like to add my voice to those who have been saying how i'd like to thank the folks at

hud and hhs as well as mya ruppart for putting this together. it's encouraging to see this family and in sort of a fearful signs, some an area, even though he was not surrounded day in and day out by other residents who were.

this can lead to disaster and, indeed, this gentleman hanged himself. there was nobody making a video for him, so hopefully we can start to thank you. [applause] >> i'd like to thank my

colleagues from hud for inviting me here today. i just want to tell a couple stories to start. in 1999 i was an civil rights division at the department of it came out this year affecting communication, family centered

care for the transgendered. it outlines the way that nursing homes can provide lgbt community. for those of you who are attorneys or advocates it talks about ways we can use our existing statutes and

regulations to protect the rights of gay men and lesbians. for there is no federal statute that prohibits discrimination on the basis of sexual orientation. basis of we can use the hill buton act, title 9, title vi, section 504,

the americans with disability act and the health insurance portability and parted. specifically today i want to talk about how the hhs office for civil rights enforces sectio rehabilitation act

the nursing home context. what we have found in our office is that years ago hospitals had to adjust to providing care and treatment to hiv positive men. however, it' time for the medical break throughs to get to the point where hiv positive men are

living to be seniors in need of skilled nursing services. the sad part of that is that nursing homes have been very providing competent care, and what we have done in these cases is used section 504 and the ada health funds are prohibiting from not

providing to hiv patients on the basis of their disabilities. i just want to go straight t and talk about our partnerships with some organizations that have filed with us and i don't want to beat around the bush about this. i think change happens when you

who are trust the federal agencies enough to actually file complaints with us. aids legal council of chicago did that, they filed on behalf of an individual who had denied admittance to a nursing home.

they h if you want to continue to do that in the future we'd like you to have new new nondiscrimination policies. we want your staff to be tr is another case about a nursing home who essentially denied admission to a placement, there

was no place else for him to go, he went to a board and care facility which i think would be in california they can't give hiv care. he was in the last stages of aids, no iv hydration, no morphine drip. i can't imagine how horrible

that was. he died two months later and that was a case where we issued a violation letter of in our process if we issue a violation letter of finding the covered entity has to either take corrective action or we are going to the hhs department

appeals board to terminate federal assistance. in this case agreed to new nursing procedures, reasonable accommodations and staff training on both hippa and universal precaution. we sent them to an aids

education training center which were trained on appropriate levels of care. i want you to consider filing with us, filing with hud, filing with the department of justice because there always should be a first case and i think recent new statutes and thetested.

>> thanks very much, ken. i want to start report we did with some other organizations released earlier this year, surveyed lgbt elders who had experienced time in long term care facility and also surveyed ser others and brought up a lot of

stories from the field. raised some of the issues that have been discussed earlier today about the uneasiness that folks felt in this situation, good stories but also some difficult ones in d felt from service providers or from other residents and it's

not my topic here today but i wanted to note it, to note that it is available on the internet and also to note i brought a couple dozen hard copies with me and left outside the front door. please feel free to take a copy or two and bring it home you

with. my topic today is one of the legal barriers to accessing housing and long term care, specifically the medicaid particularly relevant here because marriage and the definition of marriage plays into the type of protections

that are available for the spouse, for the partner and the federal law in this ca very clearly distinguish between heterosexual couples and lgbt couples and in a way that is detrimental to the lgbt community. michael mentioned this in a

brief bullet this pointed out there is some improvement in the area, indeed, because of that this presentation is both pointing out a problem and flagging some improvement that has happened in the last 12 months. the big picture

things are not particularly good here but they are getting better and we can see some progress in this area that gives protection to partners that they didn't have 12 months ago. first going back 20 plus years protection from married couples, period, and the problem is, of

course, nursing facility carries extraordinarily expensive and if a spouse is in a nursing facility and paying four, five, six, seven, eight thousand might be, the couple see what they thought might be their life savings, what they thought to live on for decades go from

healthy to rock bottom. in the late 80s congress instituted some spousal impolice officerrerment protections to they would be available across the board without estate planning that was used up to that point. to that point what couples had

to do which is really a comment on the law at the time was to separate themselves legally to a certain extent, the sick spouse would take his or her resources and separate his or her resources from the resources of the s go to medicaid and be able to

say, look, i don't have anything and apply on that basis but what medicaid wanted was a fair exist theme looked at the resources of the entire couple but recognize the system should be set up in a way that to maintain a decent level of living.

currently under existing medicaid law the well spouse with keep between 20 and 110,000 in resources depending on the state. or more technically it's half of the couples resources up to 110 or somewhere between that depending what stage you are.

one can a excess income to the well spouse to bring their range to 1800 to 2700 a month. the well spouse will have 20 to 100,000 plus dollars plus in income, 18 to 27 hundred a month which is enough, not extravagant but enough so the spouse outside

the nursing facility is able to maintain a decent level of these are mandatory for nursing home and community based services as i think we all know that medicaid and the community in general is moving from nursing facility care to assistive living at

federal law makes the protection at the state's discretion for the home and community based services. most states offer equality and provides spouses protection in the lgbt to it will be mandatory for these protections to be used in hcbs

settings. the problem in the lgbt community is that these protections are available for married spouses, and the defense defines a married spouse as a marriage between a man and a woman. and, so, it is state medicaid

programs are unable to automatically extend these protections to lgbt that was loosened up a little bit by cms in june of this year in their issuance of a letter to state medicaid directors. the letters, it is a easy read whether you are a

lawyer or medicaid specialist, the letter is very honest about acknowledging what cms is offering is a way to work around the legal restrictions imp by the defense of marriage act. and it addresses these issues in three ways, dealing with leans, dealing with transfers between

spouses and dealing with estate claims important because medicaid is a loan offered to the individual. medicaid retains the right to collect from the individual's estate. there are protections offered to spouses which is why

states under this have some discretion to provide somewhat comparable protection to lgbt couples. the liens can be imposed if it is anticipated the nursing facility resident is not going to b it's a way for the state

medicaid program to latch onto the property and what cms point out this power that is grand to the state is not mandatory, the state has the ability to impose li facility, but is not obligated do so. so a state could decide just

across the board not to impose liens when there is an everything spouse remaining in the home -- lgbt spouse remaining in the home. the transfer of asset penalty generally imposes a penalty against the transfer to spouse for the number of months for

could have paid for nursing home care. so if i'm in a nursing facility and give away $100,000, cms doesn't want me to do that and go ahead and apply for medicaid, so let's say nursing care costs $10,000, they will impose a 10-month penalty, the

important thing to note is there aren't penalties for transfers between spouses. what the states don't have to impose penalties if it is concluded there would be an undue hardship based on the imposition of the penalty and they say states

could in general fine there was an undue hardship if the penalty were to be imposed on transferred between lgbt so it gives a little bit of a free pass in this situation for the transfer to be made spouse to the other.

and i'll just note in at least one state that the state has taken up cms on the invitation, this is a law passed a couple months ago in california th empts transfers and goesthatex beyond the letter, also exempts transfers of assets or income which would have been protected

under the spousal mentioned earlier, 18 to 110,000 dollars and the income 17 to -- 18 to 27. finally state recovery that notes again that states have the ability to decline to impose a a penalty if there would be undue hardship.

let's assume there is a lgbt facility, you can see the extreme difficulty caused by collecting against that person's property when the spouse or partner is still living in the home and cms suggests states could across the board fi undue hardship in that situation

which i think we can all understand why that would be an undo hardship. just note there are pluses and minuses, we are not where we should be, there are restrictions imposed by t federal law but cudoes to cms recognizing the problems and

taking steps to fix them. >> hi, good everybody. is everybody still awake? i'm actually going to move, where is the clicker here? so, i'm going to move ahead in talk about hopla and aids housing for hours but one of the

things we know now and the national aids housing coalition has been really instrumental in inspiring researchers to look at connections between housing, housing and healthcare. nancy burnstien is hire, i can give you the web address later. i want to touch on the national

aids strategy. recently released a year and a half ago, it's wonderful and many of the things it covers it talks about a national strategy to reduce hiv infection which we know housing is instrumental. not only prevention for hiv but prevention for other types of

illness because when you have housing you are healthier, it's just the way it works. improved access to care, improved health out comes and reduced hiv disparities. there are things that right hand covered by the national hiv/aids strategies, i'll tease chris

about this, particularly women's health is us. programs that were going to serve them. i would advocate the same, i don't want young people, quite anxious, i want elder lgbt and there is room for innovation.

you know, now that i know where chris is going to be in florida i'm going to go down and buy that is what i want to do. i don't want to play bingo, you know. taken -- "no" is not an answer we understand. i digressed from my aids

housing, but you can read my powerpoint. but that's really what i wanted >> good afternoon, i'm laurie cook dainels from forego which we think is the first transagain derred organization to receive significant federal funding, we are funded in part

institution on aging and department of justice and i need to say thank you for that. i will cover my presentation, many of the same issues marta covered which indicated we are on the right marra and i in agreement. i am excited to have not made up

take tissics about trans gendered people, time to go through all the statistics, you have a copy of my powerpoint in your packet. if you are accessing it from the webinar via the internet it the powerpoint is on the forges home instead i am going to be

emphasizing the implications of the statistics for housing providers. we have three primary statistic sources here, two are new this year. the first is injustice at return center on trans gendered equality.

the other is the newly published aging folks which is the study on lgbt age, you hav room on your seessments then we have some forge unpublished data. mr. bates talked about being able to identify sisters and brothers by other mothers.

what we put up points we add a lot of transgendered partners so people can't say i don't know what transgendered people look like. the first thing i want to transgender community we are talking about every sexual orientation there is.

we are the letter in the "lgbt "that includes everybody else. 24% of us or lesser heterosexually identified. partner status, we have a lot of people in the older population that are married and i believe most of these are married people or people in same

sex marriages where one of the partners identifies as heterosexual because that's what they were before. the implications for this is it is critical not to just use language that assumes people are gay or in same sex when you use that language you

exclude those who don't identify or look like we are lgbt. the partners may not lgbt so when using that language you may also be excluding us. there may be the need to develop some way of addressing anti-heterosexual bias in lgbt spaces.

income issues, as this morning, trans people have both income in general, we have a high rate particularly african-american females males, no social security. transgendered people in the study were found to be about four times as often to be --

have household incomes of less than 10,000 a we had a 32% ownership, homeowner ship rate compared to a 67% of the general population. this was prerecession, so we were about half as likely to own a home. implications,

people have lower retirement incomes, many more will be unable to afford market rate housing and we will have less home equities that can be liquid ated to be moved into another long term care housing. general discrimination i want to point out the two bottom ones on

this slide, more than 50% of transgendered people have been harassed or disrespected in a place of 90% of had some form of discriminated on the job, we're used to be discriminated against. this particular slide is our

discrimination in terms of housing, 19% have been homeless, apartment because of prejudice, prejudice,11% have been evicted because of prejudice. implications are because we've had so much transgendered skeptical of help. our violence rates are extremely

high, we have seen several studies that have found about 50% of transgendered people have survived sexual just sexual violence, that's not counting anti-- it's not counting hate crimes, domestic violence, the other types of violence.

41% of trans people have attempt suicide at some point in their lifetime. the new aging study just out found out that 48% of the transgendered respondants were more depressed. critical to establish relationships with mental health

providers who are trans savvy. healthcare discrimination is high, we have high denial of healthcare, high rate of discriminated against in healthcare. we have even to date legalized discrimination under health insurance policies.

implications, we may have more untreated chronic conditions, we may have higher disability rates. intersectional, when you cross transgendered implication, be aware of cross cutting issues and make sure you know that your potential clients

are aware you understand that we come in more than one flavor. i wanted to mention a couple other useful things to about trans elders, one is we have extremely high military service records. this was the caring and aging with pride study that you have.

we have a 41% rate of military veterans compared to 26% lgbt and that particular figure is higher than the general public. implications, we may want to develop and/or advertise at veterans administration facilities.

one thing i want to be really explicit about is one of the differences between transgendered elders and lgbt elders, we have a lot more ways we can be involuntarily outed. when it comes surgery, in the study none of the older have had surgery which

means the vast majority of us are libel to be outed with our clothes off. the other type outing is if we have identification that does not correspond with our current name and gender identity and that is a huge proportion of our

population. the third is gossip on the part of staff and other so, the implications, privacy and confidentiality policy, both what is written and what is practiced are critical. staff needs to have clear policies and training how to

handle discrepancies and documents and there is also inner group prejudice and the implications are we have to set up bias free zone and train staff and other residents on the fact we have bias-free zo finally what do trans people

look for when deciding whether or not to use an agency. number 1 issue, reputation, number 2 is your intake forms, do you recognize more male than female and out reach to the trans community, there are a couple more on the slides. the indication for you is get

your forms right and then go out and do out reach. finally my last word is housing was number 1 need in the aging -- the n has just been done -- study that has just been done. that is my contact information and i look forward to questions.

>> thank you. that was informative and thank you to all the panelists. chris, thank you for the introduction. i'm pleased to be here, i'm hillary myer, national of lgbt and talk about the cultural

competency training we are offering. okay. some key background about the national resource center, we are funded in 2010 to start work and we are on a three-year grant. we are a project of sage but we have 10 national partners doing

the work with us, t are phi, the lgbt aging pro get, opening house, forge, american society on aging, national council on aging, national association of area agencies on aging, centerlink and hundreder college. our core mission is we are

educating the aging services organizations about the lgbt elders, we are educating the lgbt community and leaders themselves in various issues they deal within their daily lives. the ways we are trying to do it website, the address is on the

power.as well as on the slides as well as on the handouts in front of you. lgbt aging center.org. we have a training institute we will talk about in a we provide technical assistance, you can call us or e-mail us with questions.

this is a screen shot from our regs instantly formed site. we bring together resources and create original content. some of the original content onousing re people not surprisingly sit nothing this room. they have les and

are up on our website. housing options, different mode hoe a number of good resources on this through it. let's talk about the training. i was encouraged to hear a number of people talking about the various training they are

doing, because this is the place where i think we need to concentrate the most right no systems are in place for older adults and now we need to get them up to speed on lgbt issues, that is really our goal in the cultural competency we are providing.

our training objective for the to help people un taking once they go back to their we have four trainings that we offer, two to the aging network, there is a level 1 and level 2. and, like i said, the aging network trainings are to get the aging service providers on board

with the lgbt issues. organizations and i think this is really quite remarkable actually because to my knowledge there are very few resources available to lgbt organizations to talk about ageism and how to ma community accessible to older

adults. it is a hugist knew our community as many of you know, huge issue in our community. it's quite co might imagine. some of benefits of our training, it was collaboratively written so a number of the

groups who are here, some not here participated in bringing their curricula together and create this national resource training and those groups are sage, the lgbt aging project, open house, the transgender network and centerlink. i was written by experts, an

organization called psi was written by people who do this as their bread and butter. and we have an evaluation expert in hunter college, they are able to look at the -- we have a pretest and post test and look at some of the results and evaluate whether or not wet are

getting through to and last but certainly not least it's offered free of charge. the talk to their staff and nterested in requesting a center.org, you can talk to me afterward about the training or

about the resource center it's .. we did a year in revurks i will you want to read more about the center, it includes our current national center trainers. that's it. >> please join me giving the entire gr

applause. i think we have time for just a few questions and you can either direct your question to a specific person on the panel or you can open it up for the panel to respond. yes? >> good afternoon, every one,

i'm from new orleans and also i'm a member of national house equalization. something we haven't heard today is what are we doing for the undocumented elderly latino population? it's something that is here, they are not going anywhere, and

>> i apologize, we had talked about it at lunch. none of us have talked about the undocumented lgbt elderly which is kind of the pink elepha so i don't know whether we'll be able to really come up with anything today, but i think it is -- this is a group of people

we don't know how many there are, but certainly in all of our communities we are seeing people in the hiv/aids community and numbers who are undocumented who have aids and are now over 50 and getting older, so it will, i'm sure, become an issue in the

are there other questions? all right. can. can i ask this of you, eric? do nursing facilities have a legal obligation to be more lgbt-friendly? >> they do. the nursing

nursing home reform law is good on these issues, facilities have a legal obligation to accommodate the individual needs of residents and this is suedia a care planningrocess and care planning process includes the resident's and family members

and care providers, so if a person, lgbt pson is in a facility ther is an entry in the care planning process say this is wt i want, this is what is bothering m,this is how i want things to happen while i'm here in the nursing facility, let's figure out how

to make it happen. >> great, questions from the audience? >> i have a question. i am interested in knowing what work if any is being done a round regulations for adu homes. in our state this is a real

issue and as i understand it they have a lot more latitude around what type regulations they are working with as far as being discriminatory, they are ha with their own families. i wonder if anyone could speak to anything they are aware of

being done along those lines. >> i can take a shot at this and make thenerbsrvio on o get bd rsg ciits,yu tang siiv i, lfoer m hatevty ecald inyur sa, th fds n' hae lot sy ab i's

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ientooaite stct eewhacbe ne buwe ilintheve initial stages. >> i would close by saying gina put the charge to us we have to be our own advocates, we talk about how do we want to live as seniors and are we going

to spend our retiring years and we have to be talking to those who provide housing, both at a federal level and state level and to make sure that we included completely as people, we are not marginalized, not force had to go in the closet and not forced to give up what

we have fought so hard for over the last 50 years. it would be a shame to have it hand tone any individual in community and yours will be the last question, sir. >> it's really a comment. >> please. >> i understand regina's point

and it's well taken. i'm a real estate developer, the housing for people in the lgbt community who cannot afford to get their own house nothing boca, that's why i came here and i think others are here for that reason. people who are making

year, i don't no how they live much less have housing, but that is the need that we have to address here. and i really give credit to the people who put this together for being a wonderful beginning. the government is going to have to step up and come up with the

bucks because you can't provide housing for people in those very low income levels without government participation, without government stimulation, without government policy making that focuses on making it happen. there are a lot of us out there

who have the certainly the programatic expertise providing the housing exists in this room but without government taking a proactive, very strong position here and which are certainly very important, but it's going to have to be money put into it and

focused on the lgbt community, not out there and maybe the lgbt pie if they scramble hard enough, that is not going to work because the lgbt community we are talking about will disappear by the time government gets there if it normal pace, i used to be in

government so i'm not criticizing anybody else. that's the point i wanted to make, we need government to get very proactive on this issue. >> yours is the last, last first of all, i've done low chin housing my entire life, i wanted to put it out there.

there's plenty out there, we are talking about the elderly poor, hundreds of thousands of people in this country, p millions and millions, not just lgbt poor. there is money out there and i keep challenging wh r t ntetth innovative in the

community and we have to learn to be innovative here too. >> a last round of applause for the group. >>> i wa from our last panel and now to talk to them. t to spend a little time to find out if you have

anything in particular that you and we invite you to -- i caught you off guard, you are all looking at me, oh, god, we have to think before they talk, what is the topic again? funding barriers a options. >> i like you to speak

>> good. anybody else got some burning issue that they hope is touched this afternoon. please. >> i know we based on sexual orientation, how do you get money and put together something for lgbt

folks? >> oka with no in adewey try that again. i think we have seen the slide over it in detail. i want to point out because it will get to a point i want to make late near my presentation

about the annual social security chin for older gay couples. that translates to a thousand or 1100 a month which when i get to the funding challenges at the end i want you to remember those numbers, what is considered affordable unit in san francisco is not

i think our house fog jest and part of the financing challenges we face relates to what we do as an organization. we are a housing sponsoring agency but also and community programs to 25,000 seniors who -- lgbt seniors who live in san francisco and we do

training and technical assistance. in terms of housing we are currently building 109 units of low income sub siddized housing at 55 union treat which is the former university of california campus in san francisco, wonderful location and i will

talk more in detail in a second. we are working and assisting lgbt seniors in need of housing today. as i'm sure it is true in most cities in the country, affordable housing in san francisco ace warded by a lottery process.

organized in terms of their paperwork this order when they go to apply for the housing lotteries. part of our mission is to get lgbt seniors better represented in the existing senior house nothing san francisco which is a difficult and time consuming

process. we've found rejection being such a psychological process is difficult. they don't get selected, not then they don't apply again. we need to make sure they are well represented in the process. a big party want to make sure

what you walk away with, our model is based on the combination of housing with on-site and accessible somebody asked earlier about assistive living and other housing, our goal at open house is to build 109 units of housing which will be for independ

department living and we want people to be able to move in and stay there for the rest of their possible, they will need to move into an assistive living facility. we want enough on-site serviced or contracts with other agencies to make sure people who move

into 55 union street can hopefully not have to move again. we provide a very extensive services and community bidding program. right now we run a senior center but without walls, we work with our local lgbt community to put

on these programs, work with senior services, our goal is to bring services which is extensive, bring it to the 55 union built. we envision or housing and social activities will have a hub that we will create that

will include affordable housing and all the other work we do both for the residents to take advantage of but also for the larger lgbt community. our vision toys have support and social services on-site for residences but make our building and make our housing very

interactive. we want the community to feel welcome there. and we do provide training and put in a plug for the touch and go service center, it's amazing, one of our staff is doing a training for the national touch and go center, i would highly

recommend looking at the website and their training program. i want to talk more specifically about our housing at 55 union street. basic artist rendering what we hope our building will look like, we're not quite there, we are getting started on the

specific design and engineering work, but as i said our goal is to create a community. really briefly, i thought it was important to talk a little bit about the history of the project, emphasize how long it takes to develop any kind of project if you are thinking

about embarking on such a task in your city. we got founded in 1998 as an organization, we got started in earnest earlier in 2002, we did a very large community-based study. it took us six years to find a site that would work, we had a

lot of fits and starts, projects and sites we thought would work, fell through, you have to be patient and very persistent about such a strategy. we did a market analysis of the housing needs for the lgbt community, we spent a lot of years, my point being making our

case we needed lgbt welcome housing in san francisco and did the research to back that up. fast forward to the last few years. in 2008 the city francisco agreed to finance open houses building, we had actually started off i should have said

with a market project, we were going to build an assistive living facility, we ended up, i won't go into all the details, building low income housing and sub siddized housing, sub sid sub sid siddized by the city. they agreed to subside eyes the housing development.

i want to mention this year in terms of collaboration and changes, our development is one piece of a very large development. the larger part of the development is actually a private market rate rental project not just for seniors but

anybody who would like to live there, there will be 330 units of those multifamily market rate that will be developed as part of the project. our piece will be 109 units of senior affordable housing, so you are combining two project into one that the city of san

francisco has titled one big project, so there are many different players involved which creates a lot of complications and working with a private developer and then senior affordable on our piece but we have to go through the city approval

process together because it's titled as one project which makes things very complicated. development basically stopped in san francisco as the economy collapsed. the city said we don't have any money to develop your housing plan, the developer

filed bankruptcy. so when the market rate project tanked, so did our project, we were titled together and approved t a few years to get the project back on track but speaking of collaboration, we decided in 2011 when the city came back and

said let's try to revive this project, there's a new market rate developer came on board to the whole thing got started we made the decision to partner with a large developer of income, especially senior housing. we took a lot of time to see who

we wanted to collaborate within terms of building affordable housing, there were a few options as i'm sure as in your communities. we sat principals in each organization to make sure our desire to build lgbt welcoming housing, our

desire to make sure services were on-site, we had a list of questions we wanted to ask them before beginning to collaborate. we decided took us three or four months to hammer out a partnership agreement, to make sure we understood what it was we wanted

to achieve with this project, they bring come enormous expertise developing affordable housing which ownant of moving -- component of moving the project along now that it has been revised. the model at 55 union street, 109 unit, mix of some studios,

mostly one bedroo affordable up to 50% of the area median income in san francisco so everybody who lives there can't make more than about $45,000 a year as a single person. we are actually going to be building two buildings, one will

be funded by 4% and 9% tax credits and local housing dollars. and the other we hope will be a hud 202 financed building. and i think as i'm going to get to in just a second in terms of challenges. hud 202 is a

competitive process obviously, only one or two awards in san francisco are made every year, we're hoping to get one in the next few years. that, of course, is heavily sub subsidized. one only pays 30% of your chin in terms of rent.

for the one subsidized with city dollars make sure we make the distinction. mercy and open house will co-own and co-op rate this bidding, don't need to go into all the details. again if you are thinking about

collaborating with another agency or developer, really important to make sure you hammer out agreement who will be doing what, who will manage the guilding, who will recruit to fill the building, who will provide serviced, important relationship to structure.

we will have the open house offices, our intention to move our whole service program to this new building and create a new space in addition to the lgbt center we currently use, we wanted to build an efficient senior focused space, include a dining room, kitchen, activities

room, et cetera, that is really focused on seniors. i have talked a little about lack of local funding, economy completely tanked, nobody was bidding anything, the mayor's office on aging, they get their money from the fees that the have to pay a certain percentage

of -- into this affordable housing fund. if there is no private money coming in, the last three years that fund has not grown by a dime because nothing has been -- nothing has been developed in san francisco. people are coming back into the

market, economy is getting better in terms of private investment, the dollars are coming in, we had to make and i know mark will talk about it about the politics how you make very hard to make sure that the city of san francisco having committed to us back in 2008

they would fund the project, still to prioritize, nothing has gone forward because of the economy, we had to fight very hard. it when the choices came which successful getting ours to the top of the list. we will deal with a historical

place, the site is on the historic register, we have to go through a ve that hud will ultimately approve. national environment policy act, we have to go through an assessments of all the historic a year, we will need to combine

the straddal tax credit hud 202 funding along with other funding for the open house, we can't use hud 202 to build a community together it's going to be very challenging and obviously the money -- cbg got cut -- okay, i'm getting to the end. this is really the last thing,

the last thing i want to say which is really important in terms of the very -- the relatively high rents we would need to charge for our tax credit financed building. if we don't get hud 202 funning and have to build all our buildings with tax

right now san francisco allow you, this is based on somebody who makes $45,000 a year, the maximum rent that san francisco will allow you to charge is 30% of somebody's income but the vast majority that open house serves makes far below this amount of money, so for us to

serve the people we need to serve we must and we will heavily rely on that hud 202 subsidy in order to make it work, otherwise we will fill the unit but not with people who are most in need and i think that is our biggest funding challenge as we figure out based on income of

rent and subsidies we will get how we will finance and make the building operate. okay, i will stop there. sorry. >> i'm mark from the dhm fund in philadelphia, and we are here to make you $19 million.

there will be 56 one bedroom units in a b structure, 10% of the units will be fully accessible, additional units will accommodate the need for the hearing or visually impair. early seed money, again being politically connected in your

community, our governor two years ago gave us a grant, community development grant, we love those words for $500,000. that $500,000 was meant to seed this project, work with youth, seniors and hiv in the lgbt mean that we were able to go out to all the organizations of our

community and cry ate -- create partnerships saying we want you involved in our community. if we can get them involved by giving them funds, you have support from your entire there is not an organization in philadelphia who is not supportive of our structure and

building at this point. [cooptioning will continue shortly] >>> we now have $8 million. our last step is to get 11 million in private equity and raise the sale of low income tax credits. so we got the 500.

that 500,000, aside from seating our community organization also paid for our attorneys, our consultants to get us everything we have needed. those consultants put together all the studies we needed, environmental, where to be located, so on and so forth, and

i'm not going to go through all of that for you. especially because he's going to tap the table very shortly. we have been through that. every project like this need to have a commercial development partner. extremely important.

they bring several things to you. no. 1 the most important thing they bring to you is expertise. we chose pen rose development because it's the largest developer of affordable senior housing in pennsylvania. they manage over 11,000 units.

that's very large. they have been doing it for 40 years, and the reputation is stellar. they bring upon them the expertise to fill out all the documentation to do all the funding for all the bureaucrats in state government.

our funding, we are before the pennsylvania housing committee for the final piece of our funding. that's $11 million. that's the final piece, and we are in. that is like theer. they will also manage our

buildings since they manage 11 million others. we have gone through that, and if you it. >>> gosh. seth and mark, and 0 what do i do

if i squint a lot, it's because i'm still on that curve. okay? forward? i just want to talk a little bit about our history, and it's important. here we are in washington, d.c.

and begs to talk a little bit about history. the year 2000 gay and lesbian elder housing was for the services, and gray davis kind of put out the word for the the general mainstream aging community to look at seniors, and how they are cared for in

terms of long-term care. if there are options outside of nursing facilities, how can we support and how can we identify. through a group that was given to the center, the alliance got together and began to figure out what the lgbt elders needed. in 2001 when the grant was

expiring, and there wasn't the capacity and resources to continue that work, gay and bessly an lack of support for lgbt elder there was more market research done, kind of trying to figure out what are the needs, continuing on with what was

started in in 2005, we secured a for profit housing developer, and there was land acquisition, and we applied for and secured funding for political support like both mark and set these are all the players that were involved, not to mention

the $1.5 million private this is all blood, sweat and tears, and this is what went into creating the brick and mortar building that sits at the it's not only about what you know, but who you know, and i have to tell you that i would be extremely remiss if i didn't

thank assistant secretary mercedes marquez for her work. triangle result of her passion and her concern and her investment and involvement. so forever it will go down probably as -- -- we should call testifies absolutely

instrumental. we did community outreach, and you talked about how do you build for lgbt elders? how do you do and you know, i think it's how you do your outreach. it's how you do your outreach. lori brought up

antiheterosexual bias. it goes on, and our building is 90% lgbt. they are afraid it's going to be taken over. and something we need to talk about, but maybe another time. in 2 on 06 we put out reapplications and 2007 full

applications. 2007 june, the first residents moved in, and the first was transgender female. 2007 the final unit was leased and 2008 to 2010 we have been developing th here is tr it's a swanky place

our developing mccormick and salazar. it always takes a village. the building has 135 unit. 35 units homeless and or at risk of being homeless. 99% occupancy since 2007. like i said we have 90% lgbt

occupancy. average age is 75. most of our residents are at or living below povert really very staggering. 85% of the residents are living with at least one chronic health condition, and we have lost about 10% of our residents to

death, and 32% of the residents have hud vouchers, and we have talked about sustainabi to the residents, and they decide to move out of our building, and there goes that lovely hud voucher. so it becomes, i think, critical when you think about

sustainability and what that might mean for building. the two areas of service delivery i like to look at it as housing and services, and they go hand in hand, and i want to talk a little bit about program model, not to belabor

comprehensive housing care but we ta residents in a safe environment. our model is clients focus, and we do economic case management and aging in place and health and wellness, but it's really key, and we are talking about sustainability,

residents staying at home, in their home, independent home, as long as possible, and it's about the building, and keeping the building going as long as possible. it becomes kind of a -- we become interdependent on one another.

i'm going example of and. she was a 75-year-old woman. lost her partner of 45 years, and spent most of her nest egg on the care of her partner. was at risk for homelessness, she had limited support network, and multiple health problems,

not to mention the depression, and anxiety and caregiver fatigue she experienced after the death of her partner. this is kind of it takes a because this person called sage who made the connection with us, and ann and her partner had been on our waiting list, and we were

able to provide housing for ann. we have been working on getting -- she received a section 8 voucher, and i do economic case management with stay without too much stress, living independently. some of the services she gets with us, and with the gay and

lesbian center, and like leeza's place, social activity, and community activist and so i invite any of you who need stories to contact me, because ann will do it. what were some of the obstacles? mark would say -- and i'm sorry. he's not dead or anything

just down the street from us. but mark would say maintaining a developer mindset. this is about business, and this is about building affordable housing, and you kind of almost have to put social services on the side and focus on being a develop are.

socioeconomic situations, and you are going to be housing people who are in poverty, and that means a lot not only for your building and how you are going to sustain it, but also how you are going to sustain the and will be housed in your project.

is there a consumer demand? how do you strike balance between your desired mission and adhering to housing laws? i have to say that we are a mission driven organization the social service. it's all about the resident and keeping them there, and keeping

them there means keeping the building afloat. i want to talk a little bit about the challenges. how much time do i have? two the three organizations housing developer, managing general partner and the social service

provider. here is where we talk about sustainability, and i think this is where it all kind of comes when -- i'm the director of social services now, interim executive director. when mark was there we saw it as a triad between the manager,

social services and the owner of the building. oftentimes as those of social services know, many will come with one specific thing, it's really just the tip of the iceberg. so too goes in-housing. when you are sitting in the

manager's office and somebody is not making their rent or passing their inspections or somebody is getting locked out for the tenth time, there's something going on. so what we have, we have the beautiful kind of way that we work.

the management lets us know. although we are social services there and we provide services it's not mandatory you take advantage of our services. you can live independently, never see me, never see an intern and live happily ever after.

i have the frequent flyers that come all the time. management often is the first one who might see some of these there's something happening and gives us a referral so that we can go and try and figure out what's happening so we can keep these folks there at home as

long as possible. when someone is late on their rent, t that eviction notice or that three day pay or quit or that warning right away. they may get a call from sheila or visit from sheila to find out what's going on, and how can we

help. the opportunity so the idea when as they are aging in place and they don't have that safety net, they have us right there. so if something is happening we can go in right away and find out what is happening. if someone is collecting too

many items, is getting over extended with the things that they might have, then we talked about the collaboration. we collaborate with everyone. in terms of funding we had to. we collaborate the gay and lesbian center, and a

protective services and section 8. all of the ideas that our residents stay with us as long as possible. i want to say it's twofold. i don't want to seem heartless when i say it's important that we maintain occupancy

continue sustainability for the but most critical, it's for the residents. when you talk about the lgbt elders and our folks in poverty, what really needs to be brought home today is that when you creative as possible becomes critical beyond imagination, and

i know you all know what i'm talking about. that's what i say in closing. this is a dream, and it can become a reality. with the same kind of tenacity that our elders took to the streets, and this is their legacy, that they leave us to do

the same for them, an it will be us doing it for ourselves. so thanks. >> we have 10 minutes for questions. step to the microphone. >> we have one question that came in via e-mail.

>> whoa! >> somebody is watching out there. >> i think all the panel can comment on this. but the question is in each of the developments that you described, how will you or do you ensure that o

population is served? will there be a preference for them to float atop of the waiting list, and if so, if the project is subsidized for hud for money will they allow for the project? >> our projects will be open to everyone.

we will not be able to discriminate based on sexual orientation.or it is a matter for us, as of alluded to, it's very important we are organized around affordable housing in general. when it comes to the open house

building, i want to make sure they are very organized so when the applications are done, they|| will be right there at the lgbt to be filling them out so we can make sure the lgbt population is well represented. we won't discriminate and can't discriminate and shouldn't

discriminate. it's a matter of making sure our folks are well organized. >> role model from the jewish federation of philadelphia. there are jewish homes, and catholic homes and presbyterian it's lgbt friendly, when people come and visit the home, you get

to show them various things. what our friends at the jewish federation did was they made sure the opening visiting day were fridays and saturdays and took them and showed them how the members of the home went to temple on friday and went to temple on saturday, and then

they had a jewish cooking class and basically you show them that the home is primarily for lgbt activities, and usually the only people that were going to live in your house are those lgbt and those who are lgbt allies. we won our allies. why shouldn't they be with us.

but we got part of that example from triangle square. they are the only ones opening, and by the way, i forgot to mention this during our presentation. we are now before thsa for our tax credits, which is the last portion of our funding, and the

answer on that will be this april. if we get our tax credits in this april, we will do ground breaking in 10 months, one month from next month. >> i guess maybe ditto is appropriate. but yeah, i mean we comply

completely with fair housing laws, and we can't discriminate at all. like i said, it's about outreach and how visible you are, and making sure you are visible in the community and let them know what's out there so you can, when you are taking applications

applications, it's our community that's coming in responding. this is how you do your outreach and where you do your outreach really. because we can't discriminate. >> do we have relationships with advanced care facilities so somebody no longer lives

pendently they don't have to go into a nursing home and back into the closet. >> we have some of the skilled nursing facilities that are kind of seeking us out, and very interested in providing an environment for our residents. when i say it's a mission driven

that when you are once part of triangle square community you are kind of always a part of and there are many members -- that's an over statement. there are folks that have gone to skilled nursing and i make sure i visit them, and if there's any issues that i can be

the advocate, so that i can be there and at the treatment care meetings, and we can talk about the kinds of issues that they have, and yes, i guess that was a long answer to say yes, we do have relationships. i know in general we all know our communities, and we all know

what skilled nursing facilities are, that we would be okay with ourselves and places that wouldn't. just in general, that's what i'm looking at first bottom line. how will they be cared for as a patient, and then also how are they going to be cared for as a

member of the lgbt community. >> from an open house perspective, it takes so long to develop anything in san francisco, we have taken advantage by developing really good relationships with a lot of different providers, so when we do build our building, we will

be prepared for that in addition to a multitude of others that will happen. we make sure we have the relationships and we have already preidentified the lgbt friendly services. we do that all the time, and serve 3 to 400 seniors a year.

they call us to ask what is lgbt friendly, and sometimes assisted so i think, you know, to piggy piggyback on what sheila is saying, whether you do it before or during or after, it's important to have all of those relationships in place. you are never going to be able

to do it all. whenever you are part of the community, you are always part of a open house. we want to follow you wherever that may take you, including hopefully to, you know, the open house building or if that doesn't happen to living

independently, to living in an assisted living facility. but working in those relationships takes a long time and you should start yesterday to make sure that's all in place. >> we believe what we are doing is pioneering and breaking

barriers, and we saw we had an opportunity to encompass all the senior organizations that currently operate in the five county philadelphia area. not just lgbt organizations but all organizations. in fact we have one that partners with us now.

larry from the senior law practice in philadelphia. also to incorporate through the day, there are members of staff from our congressional delegation that have been here, and christina is here now from senator casey's office. keep your political friends

close to you. they have been here all day i believe our mayor is watching this webcast right now. we have been building that support system. the mayor, once i turned 60 years old, was kind enough to appoint me to the philadelphia

commission on aging, and right now i'm officially old. what that commission does is it worked with every single organization in philadelphia delivering and giving senior care, and therefore we are now implementing into each and every organization an lgbt structure,

and outside of that they got all of these organizations together, and they are as a group supporting this project because very simply there is no lgbt senior housing in philadelphia or pennsylvania. this will be a first. >> i think we have time for one

last question. >> hi. this is kathleen sullivan from los angeles, and this might be a question for sheila bec has the experience on site. but we in our program have a lot of age variation. so there are a lot of different

experiences that our seniors have, and i'm wondering from a housing perspective a sort of, you know, as someone ages maybe reduce function nationality, are there different challenges that you see and you face at triangle square based on the different ages of the

residents? >> the first thing that popped into my mind would i like to say and what i hope the service that we deliver is that when you are homebound at triangle square it's much different than if you were homebound in the community. you are homebound in your

apartment but most of us know about it and other residents are there, and so i guess the diversity of need is certainly there, and it's someone who is aging in place and becoming -- having more and more acute episodes from the chronic diseases that they might have.

the rest of the community, those who aren't so challenged by their health situation are coming to their aid, so i guess if you want to say for some of them we are coordinating their care and trying to do kind of like the share the care model and creating a community around

them to get them to doctors and get them to surgery, and some were talking about how to get a new car, because that's their main way of transportation or helping them deal with going from being independent in their car to taking the metro and getting on the bus.

what that means in terms of lost and challenge, and there's absolutely -- it may not necessarily be on age, but actually it may be related to a certain person's health status rather than age. >> we have somebody who is in his 80s who'll take anybody

anywhere in terms of the doctor's visit and then some. we have folks in their late 60s, mid-60s who are much frailer than he is. so it's about identifying, i guess, need in the community versus age, and then also being able to craft community and

capitalize on the care that the community has for one another. i will tell you my residents would not say. they will say we don't have they would say there's no they are triangle square. do you see that multipurpose room?

there's only five people coming for some of those classes. but you know what? i will tell you, the way the community is is when someone needs to get up at 4:00 in the morning and take them to the doctors, there's usually somebody there.

either somebody there because one of the residents have offered or somebody is there because we have talked and we have worked with them. to me, that's -- and i think they see it. but in little drips and drabs. it's kind of hard.

thanks, sorry. >> thank you very much.

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