Yep, I got schooled…

By Amy Schectman

From time to time I publish articles that go contrary to conventional wisdom knowing they will frustrate and sometimes even make people mad. While it is not particularly my goal to make people mad . . . in fact, I rather hate making people mad, because once someone is mad, dialog becomes almost impossible . . . I also think it is vitally important that we challenge existing assumptions as a way of doing a better job of servicing seniors.  

The other thing I frequently do is write headlines that are more strident than the article body (that is not the case in today’s headline) for the simple reason that if the headline is not thought provoking, the article could be Pulitzer Prize worthy and yet never get read.

Finally, frequently when I publish one of these articles, two things tend to happen:

    1. The number of unsubscribes from my email list jumps a tiny bit.

    2. I will get an email from a reader telling me I am a terrible person or clueless or something. In each case, I suggest that the person who disagrees with me write a rebuttal, and I promise that I will publish it. Not a single person has ever taken me up on that offer until now.

I am delighted to be able to publish the first ever rebuttal written in response to my article titled “The Bogus Affordable Senior Living Problem” It is a bold passionate challenge by Amy Schectman, the President and CEO of Jewish Community Housing for the Elderly in Brighton, Massachusetts.  –  Steve Moran

Amy’s Response

I have had a hard time crafting a response because this article offers nothing that allows me to relate it to the reality of working in the affordable senior housing field. I suppose if one reads this from the perspective of the demand for very high-end units only, perhaps it reflects market realities. If it’s meant as a reflection of the need for senior housing overall, it’s hard to imagine you are working in the same country we are.  

The Housing Demand

Our housing is in incredible demand — the worst part of my job as CEO is talking to disappointed applicants, who are trying to get me to maneuver our waiting list to get them in sooner because they feel so desperate. Some of the stories are hair-raising. Honestly, it’s impossible to be working in this field and not encounter these “horror stories” that you claim do not exist.  

I have had many a tearful afternoon as I feel so helpless: as a provider of supportive, affordable senior housing, we have a waiting list of 1400 households for 1200 units, with turnover on average at the rate of 5%/year. The wait list would be longer, but we closed it at several properties because the wait is so long that it’s meaningless to even be on the list.  

The wait lists for much less supportive, and even relatively inaccessible (walk-ups) of my colleagues is multiple years long and growing.  The Harvard study documented a FIVE MILLION UNIT shortfall in affordable housing for seniors by 2030.  

A Matter of “Choice”

To respond to your specific points:

  1. You refer to 90% as “choosing” not to buy what’s for sale. Seriously? Who can afford the CCRC products on the market? These are aimed at only the very high end of consumers. We have no evidence to suggest that if prices were modest, people would not choose to come in.  

    Seniors in the middle of the income distribution make too much to qualify for subsidized housing but far too little to ever afford high-cost assisted living and CCRCs. Unfortunately a mid-market product that offers the chance to age in community with programs, supports and health and wellness services cannot operate solely on the rents middle-income seniors can afford, so it doesn’t get built. 

  1. The government has an incentive to support senior housing, since it’s the only way to avoid excessive nursing home placements, which are indeed costly to Medicaid.  

    The definition of senior living community is NOT a Medicaid-funded nursing home, unless you are very poor and end up there prematurely because you cannot get into affordable housing. There are thousands of high quality affordable INDEPENDENT senior living communities across the county, developed by not-for profits under the Federal 202 program, that offer affordable living with supports and services that keep people out of expensive nursing homes at a far lower cost to the federal government. 

    As mentioned above, the wait list for our communities in the Boston area is anywhere between 3 and 9 years so the idea that there is no need or want for affordable senior housing is ludicrous. And as the Harvard study conclusively documents, the aging Baby Boom generation will dramatically increase this demand.     

  1. Assisted living, at least in Massachusetts, is primarily a high-end market product. Most assisted living communities around us don’t accept Medicaid waiver programs. The rates are so far below what it costs to operate a quality program, not to mention opportunity costs for high-end consumers, that it is not in any real sense available. 

    I’ve also often observed that when private payers run out of savings (as most seniors will by their early 80s), rather than transition them onto a Medicaid waiver program, assisted living facilities typically ask them to leave.

  1. I cannot imagine where you get the notion that people are not unnecessarily in nursing homes or sacrificing basic necessities.  

    Just one of the many examples we have witnessed: when one woman moved into our community she begged us to not tell her family that for the last 2 years she had been living without heat (in Boston) because she could not afford the bill and the rent. She worked hard her whole life, saved as much as she could, and found the rental housing market running away from her in her later years.

    Many others have shared similar stories. Again, according to the Harvard study, one-third of seniors are housing-cost burdened, and as a consequence cut back sharply on other necessities.  

    “On average, they show that severely cost-burdened households spend more than 40% less on food than households living in housing they can afford, making clear the link between hunger and high housing costs among older adults. All older age groups with housing cost burdens reduce their outlays for transportation. Severely cost-burdened households aged 80 and over cut back most on health care with outlays that are 59% lower per month than those of households in affordable housing.”

The market does do a good job at matching supply and demand for those with considerable financial resources. It has never been effective at serving low-income people especially in high-housing-cost regions. By definition, if the rental income folks can pay is less than it costs to operate the housing, the market will never address it. Fortunately, many of us are — and all of us think the need for increased supply is anything but bogus.