Fong Law Group

HUD Housing Programs That Support Aging in Place

Ninety-three percent of adults 55 and older want to remain in their homes as they age, according to U.S. News & World Report. “Aging in place” involves growing old comfortably and safely in one’s dwelling.

As adults age, they may want to remain in their homes and communities for several reasons. For one, remaining in one’s own residence preserves independence.

When older adults remain in their home, they can continue local activities they enjoy and maintain their routines. They may be better able to maintain their quality of life.

Staying in the same community fosters social support. It makes it easier to sustain relationships with friends, neighbors, and community members. Seniors who need long-term care services also may be able to receive at-home care.

Several barriers can prevent seniors from aging in place. Rising housing costs, home maintenance, and lack of accessibility can prompt older adults and their families to consider senior living options, such as assisted living.

The cost of housing can be a particular burden for retirees on fixed incomes. More than half of older adult renters are cost-burdened. This means that they spend more than 30 percent of their income on housing, per the Joint Center for Housing Studies of Harvard University.

The Department of Housing and Urban Development (HUD) administers programs that can help older adults age in place. HUD programs supporting seniors include the Section 202 Supportive Housing for the Elderly Program and the Section 8 Housing Choice Voucher Program. Note that moving residences to participate in one of these programs may be necessary. However, these programs can help older adults remain in communities rather than entering assisted living or long-term care facilities.

Section 202 Supportive Housing for the Elderly Program

The Section 202 Supportive Housing for the Elderly Program incentivizes the creation of housing for low-income older adults. The program funds eligible private and nonprofit sponsors to create senior housing.

Section 202 housing provides support services essential to aging in place, such as cleaning, cooking, and transportation. This type of housing is available to households with at least one adult 62 years old or older. The individual or family must meet the program’s income requirements. The household income must be less than 50 percent of the Area Median Income (AMI) for the property’s location.

Residents of Section 202 properties typically pay 30 percent of their adjusted household income for rent. The federal government covers the remaining costs.

To find Section 202 properties, consider reaching out to a HUD-approved housing counselor for guidance. Note that, as HUD does not handle leasing, prospective renters must contact a property manager or owner directly.

Section 8 Housing Choice Voucher Program

Through the Section 8 Housing Choice Voucher Program, low-income renters who are older can select privately owned housing of their choice that meets program requirements. This gives older renters greater flexibility in choosing housing that meets their needs. For example, they may be able to look specifically for accessible housing.

Public Housing Agencies (PHAs) administer this program under HUD. Participating households receive a voucher. The program pays a housing subsidy directly to the landlord for the participating family or individual.

To be eligible for Section 8 housing, families and single people must meet certain requirements. Generally, their income can be at most 50 percent to 80 percent of the median income for their region.

Apply for the Section 8 Voucher Program by contacting your local PHA. HUD offers an agency directory. While waiting lists for Section 8 Housing can be long, some PHAs prioritize older applicants. HUD permits PHAs to prioritize certain applicants, which can include older adults.

Speak to Your Elder Law Attorney

Both Section 202 and Section 8 programs offer housing for low-income people. However, Section 202 specifically serves households with older adults. Section 8 housing is available to low-income households, including but not limited to families with older members.

Section 202 participants are more limited in their housing choices. They must reside in specific approved properties. Meanwhile, Section 8 participants have greater housing choice.

You may wish to remain in your home for as long as you can do it safely. As you consider housing options for aging in the community, your elder law attorney can help. They can assist you in identifying relevant housing programs and applying for Section 202 or Section 8 housing. 

Will Robotics and AI Be the Future of Elder Care?

Adults 65 and older constitute the fasting-growing age demographic in the United States. When it comes to elder care, this expanding population is facing a scarcity in people equipped to support them as they get older.

One estimate predicts a shortage of 151,000 paid direct care workers and 3.8 unpaid family caregivers by 2030, increasing to a gap of 355,000 paid workers with 11 million unpaid family caregivers by 2040.

Technological advancements in robotics and artificial intelligence may be opening the doors to new possibilities for supporting aging people.

Innovations for Aging in Place and Beyond

Many older adults wish to stay in their homes for as long as possible. According to AARP, 77 percent of adults over 50 want to continue residing in their homes for as long as they can.

Yet aging can lead to challenges with mobility and memory, such that older individuals often need additional assistance to live independently. Innovations in robotics and artificial intelligence may have the potential to provide support on this front, allowing seniors to continue living at home as they age.

Developments in robotics and AI could also fulfill unmet needs in nursing homes and assisted living, increasing efficiency, helping caregivers complete tasks, and reducing the number of staff required.

Meanwhile, artificial intelligence technologies may be able to help older adults manage health conditions from home as well as receive more efficient care in hospital settings.

Robots Helping Out in Health Care Facilities

How might robots help seniors in their homes, nursing homes, assisted living facilities, and beyond? Here is a glimpse into some emerging products:

• Panasonic has developed robotic exoskeletons designed to augment wearers’ abilities. This self-reliance support robot aims to help aging people perform everyday tasks, get in and out of bed, and sit on chairs or the toilet. The device could help individuals to perform physical tasks without assistance. Another portable exoskeleton, the APO, may be another type widely used one day in health care to help prevent falls in seniors.
• The TUG robot is already assisting in hospitals by delivering medicine, meals, supplies, and tests, freeing nursing staff to focus on tasks requiring more education and expertise.
• Social robots may prove another avenue for improving older adults’ mental health. Paro, a robotic seal, gives patients the benefits of pet therapy in health care settings and dementia wards where bringing live animals would be impractical. Similar to pet therapy, some individuals may find it easier to connect with robots than with people.

In the coming years, other kinds of socially assistive robots may become increasingly common in elder care. These types of robots engage with residents, provide entertainment and interaction, perform tasks, or help ensure safety:

• A socially assistive robot called Stevie, designed at Trinity College Dublin in Ireland, was tested at a Washington, D.C., nursing home from 2018 to 2020. Stevie entertained residents by telling jokes, playing bingo, and leading karaoke. It also provided reminiscence therapy using stories and music and could clean the facility with ultraviolet light. Recognizing commands like “help me,” the robot also can alert staff when residents needed assistance.
• Pepper, a humanoid robot funded by the Minnesota Department of Human Services, is similarly designed for socializing with residents. Able to recognize faces and read human emotions, Pepper is being introduced into nursing homes and other elder care facilities.
• Aeo, a robot created by Aeolus Robotics, interacts with residents socially. In addition to taking selfies with residents, it performs various essential functions, such as disinfecting surfaces, opening doors, pressing elevator buttons, and alerting staff when a resident has fallen or needs help.

Technology at Home

Older adults who live alone and people with disabilities can already use Personal Emergency Response Systems (PERS), also known as Medical Emergency Response Systems. These lightweight, battery-powered wearable devices allow individuals to call for help at the push of a button. For an installation fee and a monthly monitoring charge, users receive a device that contains a radio transmitter and a console that connects to a telephone. An emergency response center monitors incoming calls.

Technology using artificial intelligence, motion sensors, and camera monitors can also provide more comprehensive assistance and monitoring for seniors aging in place:

• CarePredict, a device worn on one’s dominant arm, tracks the wearer’s activity. When it detects deviations from behavioral patterns, it alerts a caregiver.
• With Envoy at Home, caregivers can place small sensors in their loved one’s home that alert them when their loved one could be at risk, such as when they leave home, exhibit disturbed sleep, visit the restroom frequently, or display inactivity.
• Integrating AI with smartphone usage is one more emerging area in senior care. A 2021 survey by Pew Research Center found that the majority of older adults use smartphones. Technology utilizing smartphones could make in-home health monitoring more accessible, particularly for homebound seniors who may postpone doctor visits or rely on telehealth.
• With AliveCor, older adults can monitor and track their heart activity on their phones. AliveCor is a wireless personal electrocardiogram (EKG) placed on the back of the smartphone. Using an application, individuals can view their EKG results and can share results with their cardiologists.
• Using the smartphone’s camera, artificial intelligence, and machine learning, Healthy.io makes medical assessments of urine by analyzing the concentration of chemical elements and chemical compounds in urine.
  Healthy.io also empowers users to take photos of their wounds for a digitalized wound assessment, which can track healing and help doctors make recommendations.
• Luminostics is a diagnostic platform that attaches to a smartphone. It can recognize bacteria, viruses, proteins, and hormones from bodily fluids.

A Growing Market

Advances in medical technology are already helping health care providers manage, identify, and treat medical conditions in older adults.

According to Healthcare Dive, the Food and Drug Administration (FDA) authorized 91 AI- or machine-learning-enabled medical devices in 2022 alone. These include tools for radiology, cardiology, neurology, and more.

Going forward, AI may also become the norm for performing administrative tasks in clinical settings, giving health care workers more time to spend directly helping patients.

Is "Aging in Place" Right for Me?

Most older adults want to remain in their homes and communities as they age rather than move into assisted living facilities or nursing homes.

For those who wish to maintain their independence and continue living at home as they grow older, taking certain steps to protect their physical, mental, and financial welfare is essential.

What Does It Mean to Age in Place?

The Centers for Disease Control and Prevention defines aging in place as a senior’s “ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” According to 2021 data from AARP, more than three-quarters of adults 50 and older say they would prefer to age in place.

Health Considerations for Older Americans Aging in Place

Older adults must consider their physical, emotional, and social well-being when deciding where to spend their later years. They may consider adding supplemental services over time to help improve their quality of life.

To ensure that you will have the support you need for safely aging in place, take the following into consideration:

Resources to Manage Chronic Diseases

Disease management is vital for anyone, especially an older person with a chronic illness. Many older people suffer from at least one chronic illness. If a senior has a chronic disease and wants to age in place, they and their caregivers should focus on:

• Ensuring that spaces in the home are safe and easily accessible to make getting around easier;
• Learning about proper nutrition; and
• Increasing access to dental health services. Research has found that proper oral care can help prevent the progression of many chronic diseases.

Eating Well While Aging at Home

Proper nutrition is a vital part of caring for yourself at home. In facing potential changes to your financial situation after retirement, you may need help buying nutritious meals even after budgeting.

If you find yourself in need of meals, community resources may be available. Neighborhood senior centers, places of worship, and charities may provide a hot meal while you make new friends. If you cannot leave your home, some meal delivery services drop off food at your door for little or no cost.

Support for Mobility

Exercise and maintaining your mobility can increase overall physical and mental health even as you grow older. Seniors aging in place need to be able to move around their homes and neighborhoods safely. Aging in place is a much more realistic goal if you can walk for exercise, access transportation to medical appointments and errands, and maintain a safe environment at home, free from increased fall risks.

If you desire to age in place, consider simple changes you can make to your home to promote your safety. Examples of helpful modifications around the house include handrails, temporary ramps, no-slip bath rugs, and assistive seating.

Mental Health, Substance Abuse, and Memory Care Services

There is an increased need among older adults for mental health, substance abuse, and memory care services. An estimated 20 percent of older adults have a mental health disorder, and the total number of seniors with a mental health or memory care diagnosis is likely to increase over time.

Suggestions for addressing mental health concerns among older people include:

• Focusing on preventative care. Seniors and their caregivers should work with their primary care physician to identify warning signs of depression, anxiety, other mood disorders, and memory care problems. Preventative care can help mitigate the progress of these disorders and improve quality of life.
   
• Looking for common signs of a substance abuse problem. This is an often overlooked area of older adult mental health care. Older adults may turn to substances to deal with unresolved childhood problems or to avoid a feeling of loss of meaning and purpose. Some common signs to watch for include reduced hygiene, unexplained bruises, erratic behavior, and the smell of alcohol on their breath.
  
  If you are a senior’s caregiver and suspect substance abuse, you can find resources and support through the Substance Abuse and Mental Health Services Administration (SAMHSA).

The Need for Social Connection Among Aging Adults

Older adults benefit tremendously from social connections and interaction. People over 65 are likely to live alone, so creating a community outside the home is necessary. Feeling a sense of purpose is beneficial to mental and physical health. For seniors looking to create a sense of community and purpose, they may benefit from such activities as:

• Joining an organization or social club

• Volunteering for a cause close to their hearts

• Learning a new hobby

• Attending a religious institution

• Adopting or fostering a pet

• Using technology to stay in touch with friends and family

Wearables and Smart Monitoring Devices

Technology can help us not only remain connected to one another, but also monitor our health and that of our aging loved ones. Many devices make detailed health information readily available at our fingertips. These devices benefit seniors because they can learn more about their health and make the most of doctor’s visits by communicating effectively about their medical needs.

Examples of wearable health and smart-home monitoring devices include:

• Smartwatches and smartphones, which can track your cardiac health, fitness activity, and sleep patterns
• Medical alert bracelets and personal alert necklaces, which can aid in detecting falls or contacting emergency services when necessary
• Contact sensors and smart locks, devices that can alert caregivers when their loved one living at home leaves a window, garage, or door open, or has forgotten to lock them
• Smart plugs, which can automatically turn on and off lights, space heaters, thermostats, security cameras, and more

Money Management While Aging in Place

Money management can also be an area of concern for seniors and caretakers. Seniors want to make sure they have sufficient financial resources to remain in their homes and communities comfortably, eat well, care for their medical needs, and have fun.

Creating a budget with the help of financial counselors and geriatric care managers can benefit someone on a fixed income. There may even be volunteers in your area that offer a similar service. Being aware of how to prevent and avoid common types of scams that target the senior population is equally as important.

How Can Caregivers Help Seniors Age in Place?

Seniors often choose to age in place to remain independent and avoid becoming a burden to their family. Caregivers can support their goal by teaching them to use technology to communicate and track their health, helping them establish a budget, and setting them up with a routine that may include visiting their doctor, running errands, and making time to socialize.

There is nonmedical support that your loved one will need, too. Caregivers may opt to support their aging loved ones by pitching in with or hiring services for lawn care, cleaning, cooking, laundry, or pet care.

Is Aging in Place Right for You?

Careful planning is the best way to accomplish your goal of staying home as you age. If you are considering plans to age in place and want assistance, contact your elder care attorney.

Are You Missing Out on Benefits? Identify the Programs Available to Seniors Like You

Older adults have access to hundreds of federal and state benefits programs. Many retirees meet the requirements for these aids, yet do not know they are eligible and miss opportunities to receive assistance. Others can feel overwhelmed by complex application processes.

BenefitsCheckUp, the National Council on Aging’s online resource, helps elders identify the federal and state assistance programs for which they are qualified. The database is free to access, and the National Council on Aging ensures personal information people enter into the website remains confidential.

The resource provides older people not only with individualized reports of the assistance programs that cover them, but also the details they may need on each program before applying, including contact information for the agencies administering the assistance.

How to Obtain an Eligibility Results Report

To get personalized Eligibility Results detailing the benefits programs to which you may apply, enter your information into the database on the BenefitsCheckUp website, starting with your ZIP code. Then select the programs that interest you, which offer support on any number of services, including:

• Health care and medication
• Food and nutrition
• Housing and utilities
• Aging in place and in-home care
• Income
• Disability services
• Long-term care, such as skilled nursing facilities
• Discounts and activities
• Tax help
• Crisis, legal, and general assistance
• Veterans’ programs

Once you enter details such as your date of birth and marital status, BenefitsCheckUp generates a report outlining the specific programs accessible to you, and identifies what other information each program requires.

The Eligibility Results reports have several user-friendly features:

• If you make errors filling in details or want to provide additional information, the website allows you to go back and revise your answers.
• After the website creates an individualized Eligibility Results report, you can save it as a PDF and email it to yourself or a loved one.

Family and Caregivers Can Use BenefitsCheckUp to Assist Their Loved Ones

Family members or caregivers of older adults can also use BenefitsCheckUp to help their loved ones learn about benefits programs. They can enter an individual’s information into the website on their behalf and get a report, which they can use to support their loved ones in applying for state or federal benefits.

This easy-to-use resource can help older adults and their families alleviate the stress associated with applying to state and federal benefits programs. Visit the BenefitsCheckUp website to use the tool.

Aging in Place: Reality or Dream? 老有所屬：是現實還是夢想？ (中英對照)

“As lifespans increase, our elders grow in number, and government elder benefits become more politically tenuous, the need for empathetic family elder caregivers keeps increasing.

Seniors crave their independence and a sense of place. Almost all wish to remain in their own homes and to “age in place.” Being independent in your senior years benefits everyone. However, if aging brings illness, professional home caregiving may be unaffordable, says The Winston-Salem Journal in the article “Who will help me to age in place?”

Even though they want to remain independent, family member participation may be necessary for this to happen. Family caregivers may live with aging parents, serving as guardians, trustees or power of attorney agents on their parent’s behalf. They may perform many tasks, including cooking, cleaning and monitoring their medical or home care. They may take care of the home and take aging parents on outings.

Loyalty to aging parents runs the gamut, from daily contacts and living together, to children who vanish as soon as they are financially independent. While our biology may dictate that close family members are genetically predisposed to care for us most, it’s not everyone’s experience.

If your goal is to have parents, children and grandchildren all spend time together as the generations move through their lives, the time to start is while you are parenting. The most important thing you can do to increase the likelihood of having family members who value each other and care for each other, is to raise children with love and kindness.

You should limit the amount of time that children spend with electronic devices. Making family connections and teaching caregiving skills within the family, requires time and attention. Teach your children empathy and caregiving through gardening, caring for plants and pets and letting them see how you take care of siblings, parents, grandparents, friends and the less fortunate through volunteer work.

Our children learn more from what they see, than what we say. By teaching your children to respect and care for those they love, you will be creating a family legacy based on your values. This will be as much a part of them, as any inheritance you can leave them.

Part of caregiving is taking care of the legal and financial side of your life. Ensure that your family members have an estate plan in place, including a will, financial power of attorney and health care power of attorney. Caregiving for others involves preparing for the ups and downs of life. This shows your children that there are things we do for ourselves and for others that make life easier for those we leave behind. It is an important life lesson for each generation.

Reference: The Winston-Salem Journal (March 5, 2019) “Who will help me to age in place?”

“隨著人的壽命越來越長，老人的數目也日漸增加，政府老人的福利變得更加政治化，對理解老人的家庭護理人員的需求不斷增加。

老人渴望有一個獨立及舒適環境。幾乎所有人都希望可留在自己的家中終老。在你年老時可獨力照顧自己則令家人受惠。然而，如果年老帶來疾病的話，專業的家庭護理費用可能負擔不起，The Winston-Salem Journal在文章“Who will help me to age in place?”中說。

即使他們想獨立，也可能需要家人幫助。照顧老人的家庭成員可以與年邁的父母一起生活，代表其父母擔任監護人，受託人或財務代理人。他們可以執行許多任務，包括烹飪，清潔和監控他們的醫療或家居護理。他們也可以打理房子，並帶年邁的父母外出。

對年老父母忠誠的幅度可以從日常接觸和共同生活到在經濟上獨立後就消失的子女。雖然在生物學角度上親密的家人是最關心自己的，但並不是每個人都一樣。

如果你的目標是讓父母，子女和孫兒一起度過，那麼應在你養育子女的時候開始。如果你想能讓家人互相尊重並互相照顧，最重要的就是要用愛及仁慈去撫養子女。

您應該限制子女花在電子設備上的時間。在家中建立關係和教導互相照顧的技能,透過園藝，照顧植物和寵物教導你的子女同情心和如何照顧其人，這都需要時間和精神。​​讓他們看看你如何照顧兄弟姐妹，父母，祖父母，朋友和當義工照顧不幸的人。

我們的子女從他們看到的東西中學到的東西比我們說的多。通過教育子女懂得尊重和關心他們所愛的人，你便可以用自己的價值觀創造你的家庭遺產。這將是其中的一部分，因為他們將繼承你留下給他們的任何東西。

處理好你法律和財務方面也是照顧的一部分。確保您的家人有資產計劃，包括遺囑，財務授權書和醫療授權書。照顧他人包括為人生的高低潮作準備。這讓您的子女看到你是如何為自己和其他人做事，讓在生的人生活可以更輕鬆。這對每一代人來說都是重要的人生課程。

參考: The Winston-Salem Journal (March 5, 2019) “Who will help me to age in place?”

You Can Age in Place but You Need to Plan

“Many homeowners plan to stay in their homes over the long-term, and some may plan to live independently at home, rather than moving into a retirement community, if possible.”

Aging in place is what most people hope for as they enter their 60s and 70s.  However, to make it a reality, there is a need to plan, according to the article “BBB On Homes: Focus on several things when aging in place,” from LMTonline.com. The Centers for Disease Control and Prevention define aging in place, as the ability to live in one’s own home and community safely, independently and comfortably regardless of age, income or ability level.

Changes in health or finances don’t always allow this to happen. Here are four things to keep in mind, when considering whether you or a parent will be able to remain at home:

Safety updates. This generally includes a walk-in shower, safety rails, widened doorways that can accommodate wheelchairs, non-slip flooring, ramps and accessible kitchen drawers and food preparation surfaces.

Getting food and supplies. Food and medication deliveries are crucial to aging in place. What will happen, if you are no longer able to drive? If you depend on local stores for delivery and there is a major weather event, how will you manage? There are some non-profits who deliver but people must be open to the idea of receiving help from others.

Preparing for disasters and emergencies. Living alone makes it difficult to get help immediately after an accident. When time is of the essence, it can be difficult. There are many options, including medical alert systems and home surveillance cameras. However, the person has to be willing to have them. Arranging for a friend or family member to check in daily is good for every day safety.  However, it will not help in an emergency.

You’ll need health care and transportation. If you live in a city or suburb where there is public transportation, you’ll be able to get to your doctor’s appointments. If not, you’ll need to budget for taxi services.

Budgeting. Living on your own means more independence and privacy. It may cost more because certain fixed costs can only be reduced so far.

If you are considering how to remain at home, make sure to speak with family members, so they are aware of what your wishes are. With their support and if you are financially able to do so, it may make a big difference in the quality of your life.

Reference: LMTonline.com (Aug. 26, 2018) “BBB On Homes: Focus on several things when aging in place”

How Technology Could Support Aging in Place

“The goal: to see if researchers can monitor and detect health changes in older adults and enable them to live longer in their own homes. For example, early signs of cognitive decline may be detected through changes in computer use or driving.”

A research assistant tested and placed sensors in the studio apartment of a 75-year-old Portland, OR resident one June morning. The man was basically allowing his house to be reconfigured, reported The Wall Street Journal in the article “A Tech Test to Keep Seniors in Their Homes Longer.”  The man was taking part in a large national study called CART–Collaborative Aging (In Place) Research Using Technology Initiative.

The study will allow researchers to monitor his daily activities by using sensors and other technology placed throughout his home.

Motion sensors will feed data occurring in real time on his movements throughout the day. They will measure his movements throughout the apartment, how often and when he leaves the apartment and what his walking is like while he is in his home.

The goal is simple: to learn whether health changes in older adults can be monitored via technology to help seniors age in place. For instance, by monitoring computer use, driving or changes in gait and movement, the researchers will be able to detect changes or fragility issues.

This is a four-year study funded by the National Institute of Health and the Department of Veterans Affairs. The technology has already been installed in approximately 50 homes. However, the plan is to set it up in 250 homes. The seniors have agreed to allow these systems to be in place, until at least 2020.

While there are sensor-based monitors used by the elderly at home, no company has had any success with this complex a system. The logistics have been too daunting.

A CART system is seen as a potentially major change in how patients who are sent home from the hospital, for instance, or who complete their rehab, can be monitored.

At the recent installation, barely noticeable sensors were placed on the walls of the bathroom, kitchen and living space and four were installed on the ceiling. There’s no camera or video, just gathering real-time data, as the resident goes about his day in his apartment.

A slowed gait might indicate different health problems. Leaving the home less often, might signal depression. The hope is to find digital biomarkers of problems earlier than if the patient were seen in a clinic.

The system includes a pillbox with sensors to track medication use. A special scale is used to measure body composition, weight, heart rate and arterial stiffness, an important measure of cardiovascular health.

Most information doctors get is based on patient recall.  However, with the CART system, accurate and objective information about the patient’s behavior gives a clear picture of the patient’s health.

Resource: The Wall Street Journal (July 25, 2018) “A Tech Test to Keep Seniors in Their Homes Longer”