 So welcome to our senior housing forum today. We're very pleased to be sponsoring this with, thank you, this is Heidi, our organizer extraordinaire. Thank you, Heidi. We are very pleased to be organizing this forum with our partners at Leading Age, Rhode Island, Jim, I know I see Jim and Linda Couch from their national organization. We'll be speaking in a few minutes and Rhode Island Housing team, Barbara Fields will be up in a few seconds talking as well too, so thank you. We know based on registration that this is a very hot topic. We know this is a topic that many of us have been nibbling around the edges on. Many of us and all of us, I think, well let's just do it by show of hands. Who has an elder in their family or their life who has housing issues? Raise your hand or that you're concerned about. All right, no surprise, right? I mean that's a common issue and a common problem that we know as our population ages. I also just want to get a sense for the room if you can kind of self identify, if you identify yourself with the housing field or the housing community, raise your hand, great. If you identify with the healthcare community, raise your hand, great. We got a pretty good mix. Some people raising their hand twice, that's fine too. How about faith-based or religious organizations? I see quite a few folks from that field. Universities and government, we'll put those guys into a category together. There's a few state government or a local government. We have a few folks as well too, so great. We've got a good overview of folks here today. So thank you all for coming. As you can see the logistics are tight, but hopefully you've already found the copy. When we do the breakout rooms, we're gonna be in the two classrooms behind you to the left and right and we'll let you know which ones which in a little bit later in the program. Bathroom facilities are out right near the elevators or just before the elevators. If you need those, please feel free to move around as you need to as well. We also will be having a reception at the end which will be in the little cafe right at the elevator. So if you're still here, please stay and join us for some refreshments at the end of the program as well too. So a couple of other quick announcements too. We have on the table our fact book invitation October 11th. We'll be back in this space in the morning for some sessions and then at the convention center for our annual fact book lunch. Hopefully you've already received the invitation, but if you haven't there's some extras over there. Also just wanted to do a plug for a few other conferences that are coming up and Jim or Linda you might be saying more about this but I know Leading Age has their long-term care policy conference on Friday, September 29th. And Jim from Leading Age can give you more details about that. Also our colleagues from Senior Agenda have their annual Senior Conference and Expo on Friday, October 20th at the Crown Plaza. And we're happy to get any information to you about both of those conferences. So also hopefully you saw on the table our senior housing brief that our colleague from the Housing Works team Christina Brown has worked diligently on and Christina has been focusing a lot of her attention and time on senior housing issues. Maureen Magrid has also worked on a similar policy brief actually much longer, a policy brief around housing issues and so more to come on those resources as well too and we'll make sure everybody has links to that material post the event as well. So without further ado I'm going to turn it over to a longtime friend and colleague Barbara Fields to say a few words of welcome. Barbara. Good afternoon and when Brenda asked that question if you were worried about people in your family shouldn't worry, say if we were worried about ourselves. But I am Barbara Fields and I am the Executive Director for the last two and a half years of Rhode Island Housing and I know many of you in the room from my other years in the community and housing but for those that I don't know I look forward to meeting you. But Brenda is one of the first people I met 25 years ago and I just another round of applause for Brenda and her leadership here in the state and in housing. It is a great day when I see a room full like this to talk about housing and seniors and why is that? So number one the state is facing two housing crises production and access. Every single person here knows that it's simple basic economics. The cost of housing is simply out of reach for too many Rhode Islanders. And our job at Rhode Island Housing is to expand that supply either by providing increased production or providing mortgages to help people get into a home ownership position. And the other is to work with our partners many in this room to provide improved access, reduce homelessness and get housing into the market that meets people's needs. That's what we're here about today. What are the needs of seniors? Both crises are simply a shortage. We don't have enough. And every single day we pick up the local paper, we pick up the Boston Globe, the New York Times. It doesn't matter any national press. And there's always an article about how people are struggling. And that hurts our economy. It simply can't be grown and we have a lot of terrific efforts underway thanks to the legislature and the governor. We simply need to house our people. And we were asked to do a study. I was interested. It says it's Rhode Island ready. I would actually say it's the U.S. ready and hopefully my friend Linda will talk about that from a national perspective. Because we saw in our study that Rhode Island will grow. And I just had a discussion today. I was talking with a town administrator. He says, really? I said, absolutely. We will grow either 3% or 5% whether we follow more of a Connecticut or a Massachusetts model. The country is expected to grow 8%. So New England is always going to grow a little slower. But the rest of the country is growing. And that means where is that growth coming? It's coming from millennials and it's coming from seniors. In Rhode Island, I say we have a housing wave over the next 10 years. In recession, we lost 30,000 children. And unlike my teenagers who would like to lose me, this is 30,000 children who left because their parents were looking for work. And there wasn't work here in the recession. And they're not coming back. So the 45 to 64 category in Rhode Island is projected to go down. But millennials will go up and seniors will go up. And so what are the things that we're going to do? What are the policies and investments that we're going to make as a state to meet this? Our projections, we need 35,000 new homes. Sounds like an overwhelming number. But it's about 3,500 a year. And we were producing close to that in the 90s. And I believe we can get back there. Thank you all who supported, worked on, and got us to pass the housing bond last year. Very exciting, a step in the right direction. But just a step, we need to do more. And we're excited that bond money should hit the street later this year or early next year. It's very important. So as we grow the baby boomers age, we're finding that needs and expectations are changing. And as Brenda said, we all know someone's struggling. But we may know someone, everybody here knows someone who's 90 or over, still in their home. And we're going to help them this weekend, fix something in the house, or get ready for a holiday or whatever. That didn't happen 40 or 50 years ago, because A, people didn't live as long, and they didn't stay in their home. So as they stay in their home, what are we doing to accommodate them? We're working with our design and construction team to talk about that. We can make simple design changes at the beginning so anyone could live in a unit, whether that's a walk-ins shower. So maybe when you're 50, you can get over that huge step into the shower, but you wouldn't mind if it was a walk-in. And then later, you can live there or someone else might move in who could use that. So we're really seeing that in general. So we want to help people to age in place. So we're trying to find the solutions now. We're already behind a little. We're going to get ahead. So I'm very excited to have this discussion today. I'm very excited that Linda Couch has come from Washington, D.C. to join us. I just found out she is a New Englander. So we always love to welcome New Englanders back and show you the great things we're doing on the ground because I know she'll take those examples of what we're doing here and bring those to Washington and we need your voice. So thank you for the work that you are doing. So finally, it is my pleasure to introduce Mary Ann Romanda, who I just met for the first time today but I've been reading and hearing about her and she's doing two things, particularly that I really appreciate. She is over at Rhode Island College running an interdisciplinary program of education on education and healthcare. And I love that. I love the fact that we're healthy people and we're housing people. We need to break down those silos. We need to work together. So I truly appreciate that. And in addition to teaching, she's also getting things done. She's coming up with solutions and moving the ball forward. And in her spare time, I think she is first sister in our state. So we appreciate your time, your effort and the work that you do every day. So my pleasure to introduce her and answer to come to the podium. Professor Mary Ann Romanda. Well, good afternoon. Like all of you, I am so excited to be here this afternoon. When Brenda and Jim first started talking about holding a forum, I don't think any of us ever imagined it would be so big and so great. And I just feel the energy here and I'm just so happy to be a part of that. And to have a few minutes this afternoon to tell you about some of the things, yes, Barbara, we are trying to get things done for our older adults to share with you a little bit about what we are trying to do. So who is going to take care of you when you get old? Where are you going to live? Will it be in the same home you're living in now? Will it be in an assisted living community? Will you end up in a nursing home like many folks hope does not happen? Well, I recently have begun to think about this question because my own 20-year-old daughter who will graduate from college in May just got a job offer in New York City. And it struck me that she's leaving in June and I'm not quite sure she'll ever come back to Little Rody. I think about my 18-year-old son, much less likely to care for me when I get old. Studying in Washington, D.C. and I think, you know, might he end up settling in that area? And then I thought about my own upbringing. And I think about my grandmother who died at 62 and when she died, my parents invited my grandfather who was not much older than she to come live with us. And he said yes immediately because he didn't want to be alone. And so he moved in with us and my siblings. He had been a professional chef so he cooked for us and he yelled at us and he helped raise us. He spent vacations with us and holidays with us and he spent his older years of life doing what he enjoyed, fishing, golfing, gardening until he died at age 90. And then I think about my mom now at 86. And on Saturday I went to see her like I do every Saturday. It's funny we had a discussion about hair color before we got going this afternoon and my mother at 86 is determined not to show her gray so I color her hair. And you know, I clean her house and help her with the laundry and gardening and then we typically go shopping. But on Saturday I walked into her kitchen and her kitchen table was covered with papers. Piles, stacks, papers, envelopes, and I said mom what is this mess thinking how am I gonna clean all this? And she said oh Mary Ann I'm just overwhelmed. And I said overwhelmed with what mom? Everything, everything. I'm trying to pay bills, I'm overwhelmed with paying bills. Do you see the yard, all the shrubs overgrown? This house, there's so much to do. And I said mom come and live with me. And she responded I'm not ready. I want to be as independent as I can for as long as I can. As long as I can do this, pointing to her mess, I want to do this because I feel good that I can continue to do this. Do you understand that she said to me? Well we've heard the statistics by 20, 30, 25% of the Rhode Island population, one in every four adults will be over the age of 65. And we have the wonderful position of being first in the country in the percentage of our population that is over the age of 85. So as Barbara asked are we ready? Are we ready for this quickly growing older population? And I talk to people every day, people at the health department, our legislators, and say do you guys get this? This is happening fast. Are we ready? Have we built communities that enable people to stay independent like my mother wants to do, but yet still provide the support that prevents that isolation and that loneliness and that decline that my grandfather so feared? And the answer is no. So a few years back the Long-Term Care Coordinating Council spun off a committee called Aging in Community. Many of you served on that committee. It was a wonderful group that represented academics, healthcare providers, social service agencies, community agencies, advocates for older adults. And we came together to assess what is in Rhode Island. One, what are the needs of older adults? And two, what are the gaps in services? And so we talked to folks, we did a lot of key informant interviews, we had presentations, we looked at the data. Our work was funded by the Tufts Health Plan Foundation who also funded the University of Massachusetts Gerontology Center to look at statistics, prevalence rates, demographic statistics on older Rhode Islanders. And we go through all of this data and then we said to ourselves, hmm, don't you think we better talk to some older adults? And so we went out and we conducted focus groups all over the state of Rhode Island and we talked to older adults about their needs, their worries, their fears as they get older and what services exist and don't exist to meet those needs. We published a report which we presented at the State House about a year and a half ago and then again with the support of the Tufts Health Plan we developed a strategic plan to outline some strategies in terms of how we can, as Barbara said, do something to better meet the needs of our older adults. Well, we heard a lot of things. I won't go through it all. We heard some great, wonderful things about how our older adults really value our senior centers. I think we were all wowed by this. Older adult after older adult told me, I love it. I go, I exercise, it keeps me young. I want to stay healthy. They love the trips. They love the socialization. They love the companionship. But then we also heard about other concerns. Financial concerns like my mom. How do I pay these bills? How do I keep up this house? We heard a lot of concern continuously about transportation. I was at a meeting yesterday and a gentleman from one of the chambers of commerce in Rhode Island, we were talking about transportation said, I had this discussion, this same discussion 25 years ago about the transportation system in Rhode Island and we are still talking about these same problems today. We don't have a public transportation system that works and certainly not one that works for our older adults. And we heard story after story after bus stops not being convenient, people not getting picked up on time, people being stranded where they needed to be picked up from missing doctor's appointments on and on and on. Need for information about what does exist. No one stopped shopping. Where can we go to find out how to get help, how to get services? And we heard a lot about affordable housing. So as Barbara just said, the bottom line is there's just not enough and we heard this. We heard older adults who are renting apartments who talked about the fear of prices going up. They're not able to continue to pay their rent. We heard lots of stories about older adults like my mom still in their own home but they worry about keeping that home up. Things are falling apart. They can't maintain it both physically and financially. And then we heard a lot from older adults who are currently living in senior housing communities. And because of federal legislation that mixed younger adults, many with disabilities and behavioral health issues with older adults, there are many older adults who fear for their safety in these housing communities. And so afraid that they shared with me, they won't even go outside their apartment because they trip on drug paraphernalia or they'll be woken up at two, three in the morning by somebody banging on their door loud partying or people who are drunk and they're afraid. We heard lots about my grandfather's fear. I don't want to be alone. How can we connect these people to community to family and especially we heard a lot about Barbara alluded to people moving away during the recession, lots of older adults told me story after story about my kids are gone like I fear with my children and I'm alone. What do I do as I age? I don't have that support system. Unfriendliness of our state offices that are not meeting the needs of older adults and opportunities for older adults to become more engaged volunteering in civic opportunities. And lots of older adults can debate to us just because my hair is gray doesn't mean I'm stupid. Doesn't mean I'm not intelligent and know what my needs are. So lots of our work has been around advocacy. Certainly many of you here today have joined us in fighting for trying to not only restore senior center funding but what can we do to increase it because as I said our older adults value our senior centers and there's so much more they could be doing if we funded them appropriately. Let's learn more about these problems with transportation. Luckily we were able to keep the no fear ripped a bus pass legislation to create this website for information where older adults can go to find out about resources. Absolutely increased payment for home care and another study I've been doing clearly, clearly, clearly we have a big problem with reimbursement for our home care agencies high turnover our CNAs because we're not paying them adequately or appropriately and that all translates to a lack of those community services for older adults in their home and our ability to help them stay in their home. Restoring funds for the elder respite program expanding home care programs. So lots of our work has been at the state house drafting policy briefs trying to meet with legislators to pursue policy changes to help older adults. And then we also set out as Barbara said to do something to make change in our community. And in this work we've been guided by the World Health Organization framework for age friendly communities. Communities that are good to grow up in and communities that are good to grow old in. And so the World Health Organization and also AARP has laid out this framework of what are the dimensions of age friendly communities. Communities that provide information and communication. Communities that provide opportunities for engagement, transportation, safe, affordable, accessible housing what we're here to talk about today. Food security, economic security, support to remain at home, access to health care and then open space where people can exercise and enjoy especially in the state of Rhode Island where it's so much to enjoy. So what have we done? Well we have formed groups in each of these domains. Folks many of you have been part of that. Some of you here I'm looking out are leading some of these initiatives. I really want to shout out to Brenda and Jim who have been the co-leaders of our housing group. And as I said a few months back you know when we all get together and we say what are you guys up to? They said we're going to hold a forum. And today happened. So great job. One down, right? And all of these groups are busy doing things to try to as I said make change in our community. So our report, we have created a website, Age Friendly RI where our first report is located for those of you who have not read it. We are continuing to work, chipping away at all of these areas, transportation, housing, food and nutrition. We are starting now to work with businesses. We've begun to go out and engage businesses in the conversation about what can you do? We were at CVS last week and had this conversation, what can you do to be more age friendly for older adults? I went out and met with Amgen last week and I was happy that they want to continue this conversation. And we've also been going out to individual municipalities. So it's very exciting that individual cities and towns North Providence, Providence, Warwick, East Providence, are all interested in taking on this challenge of looking at what they can do and their local communities to pursue this concept of age friendliness. And again, I wanted yesterday, we submitted another proposal to the Tufts Health Plan Foundation. So hopefully they will continue to fund our work so we can continue on this exciting journey. So I hope today is, yes, a lot of listening. I'm looking forward to your presentation. And I hope beyond that listening, it's really an opportunity for us to really begin to brainstorm some innovative ideas for housing for older adults in Rhode Island. There's some exciting things happening with the Providence Village, a new village initiative down in South County, the new greenhouse model, it's saying Elizabeth's new assisted living community and Warwick, which is just small, more of a household. In our work, we've learned about some best practices in other states and other countries. So I really hope that today we really begin to explore what can we do in Rhode Island and forge those partnerships to make it happen. Thank you. Good afternoon. My name is Jim Nyberg, Director of Leading Age Rhode Island. At this point in the program, it is my pleasure to introduce our keynote speaker, Linda Couch. Linda is the Vice President of Housing Policy and Priorities for Leading Age, our national organization, which represents more than 6,000 nonprofits representing the entire field of aging services, including obviously senior housing. Linda focuses her work on expanding and preserving affordable housing options for very low income seniors. After 12 years with the National Low Income Housing Coalition, Linda rejoined Leading Age in 2016 to identify and advocate for solutions to America's aging population, which, as we've heard, is rapidly growing and becoming poorer. Linda has been very active in Congress, testifying before House and Senate committees, and has a special interest in the federal budget and appropriations processes. She's basically our housing guru for Leading Age down in Washington, D.C., and we are very pleased that she could be here with us today. Thank you, Linda. Thank you, Brenda. Where's Barbara? I was really excited to come up to Rhode Island. CVS is my favorite store. That's fine. I think wherever I've worked in D.C., there's always been a CVS across the street. There's always something in there I need and something I can afford. So, although we do call it checkout very slow. But no, it's really great to be here and Jim picked me up at the airport this morning. We were graciously welcomed by Bonnie at Shalom House, one and two, and that was a terrific tour of beautiful communities. And then Jim and I came into Providence and had a wonderful time with the Roberta and Ken at St. Elizabeth's Place. So, some really terrific stuff going on here. All right, a little intermission. So, I just wanted to start off with a couple of facts, I guess. At Leading Age, we represent the majority of HUD's Section 202 property sponsors. So, 202 program, Housing for the Elderly, all non-profits, they serve very low income seniors as well as some mobility impaired residents. And people often say, okay, what's happening in senior housing, what's happening in the 202 program? And I just want to make clear that from my perspective, from Leading Age perspective, all of HUD's housing stock is really senior housing at the end of the day. We look at HUD's whole portfolio of five million units as a tremendous resource, one to be preserved and one, hopefully, to be expanded throughout the portfolio. Of HUD's 1.1 million units of public housing, 33% are headed by seniors. Of HUD's 1.2 million units of Section 8 project-based rental assistance, 46% are seniors. 23% of the 2 million plus housing vouchers in use in the country are older adult headed. And then, of course, HUD's flagship Housing for the Elderly program, the 400,000-unit 202 program. So, all told, of HUD's five million units across its programs, about 34% are headed by seniors. And I'll talk a lot about the 202 program in my remarks, but please know that we work hard to protect funding for public housing for the voucher program, for project-based Section 8, as well as the 202 program. We have some disturbing statistics. I know the housing world is full of disturbing statistics, but in August, HUD released its biannual worst case housing needs report. And this is a report that they give to Congress every two years, really, usually, with very little fanfare, because the numbers are so bad and there's not much HUD can do about them at the moment. And Congress isn't usually prepared to do much of anything either. And this year's worst case housing needs report, we saw a huge spike in what are called worst case housing needs. If you are a worst case housing need case, you are a household, so you're not an individual. You're a renter, you're not an owner. You are very low income, so your income is below half of your area median income. And this is the key point. You have a priority housing need in that you're either paying more than half of your very low income on your rent, because you're a renter, all these households are renters, or you're living in severely inadequate housing. So worst case housing needs, generally very low income renter, paying more than half of your income on rent. 98% of worst case housing needs households have a housing cost burden problem and not a housing quality problem. So when the numbers came out this year, we saw a big increase nationally across all populations of worst case housing needs. A spike of 582,000 households between 2013 and 2015. 382,000 of that spike or 66% of the entire nationwide increase were older adult households. And I think that's really telling. So if you are an older adult household, you and your very low income and you're paying more than half of your income on rent, other data that we've seen come out from Harvard tells us really clearly that you are probably spending 30, 40% less than your non-housing cost burden peers on your food, on your healthcare, and on your transportation. So these are the people who are really struggling. And this is also why we have more people who are becoming seniors. But as Jim said, they're poorer than yesterday's seniors. And this is why a couple of years ago, the National Alliance to End Homelessness predicted a doubling of senior homelessness over the next 20 years. Because sadly, really depressingly, we can look at the trajectories of population increases and poverty and do a formula and see how many of those people are expected to become homeless. So when we look at the worst case housing needs numbers that came out this summer and just the huge increase in these worst case housing needs households in general across the country, but then the majority of them coming from older adult households, we see this playing out. And we see people not having enough money left over to really live. And when you talk to the data people, you say, well, people are spending half of their incomes on housing. And they say, well, if you really look at the numbers, it's not that people are spending 50 or 51% of their incomes on rent if they're in the worst case housing needs bucket. These are people who are paying 70, 80, 90% of their incomes on housing. So it's pretty dire out there. And it's especially dire if you're a renter who has a very low income. And so I want to get to how we're going to solve this. One of the mechanisms to solve it is the executive branch. Right now at HUD, Secretary Ben Carson has been confirmed, obviously has been in there several months in the Trump administration. But very few people have been confirmed to take leadership roles in any of the cabinet level agencies. Last week, HUD finally saw its nominee, to be the deputy secretary nominee, Pam Pattenow, to be confirmed by the Senate. That took months and months, mostly because Senate Democrats were very angry about President Trump's budget request for HUD. And they took it out on Pam Pattenow, I would say. Last week, so that was good news. Pam came from the George W. Bush administration, really well respected. And I think she's going to be great there. Last week also, the Trump administration nominated Brian Montgomery to head the office of housing that oversees project-based assistance and the 202 program, the 811, Housing for Person with Disabilities Program. This person is also, will be the FHA commissioner, so a really top person at the agency. So Brian Montgomery's been nominated for that. He was also in that role during the George W. Bush administration. He's expected to be, we think, pretty easily confirmed. But the nominations process is really slow. And so when we're talking about program changes, or hopefully we'll have a day where HUD actually gets some cash to spend, we need people in the building who know how to spend it, want to spend it, and are going to spend it well and efficiently. What we're faced with Ben Carson, who right now is really, we don't know a lot about his housing policy. He doesn't talk about his housing philosophy or what he wants to do with the housing programs. He ran, I would say, for months, letting people believe that he grew up in public housing, and that being a real reason why he got to where he was. He pulled himself up by his bootstraps. And then when President Trump nominated him to become HUD Secretary, that was one of the things that kind of gave him reason to be in that spot. And then it came out that he didn't grow up in public housing at all. And so then you're like, anyway. So we're not quite sure why he's there. But then he said some things that I think as a howzer are really concerning, right? So he is called poverty a state of mind, which is very mind boggling. And then he's also taken Umbridge with the quality of public housing and called the housing that he was touring as being a little too comfortable. He'd hate for people to want to stay there forever, something like that. So we have some real concerns about Secretary Carson's desire to not only preserve the programs, he's in charge of shepherding, but also his desire to expand programs to people who need them the most. And back to HUD, these are just the numbers. So under Carson, these are the national numbers, but just at HUD, HUD has 80 political appointees. 10 of them have to be confirmed by the Senate. So I think two of them have been confirmed so far. And maybe three or four of them have just been plain old nominated. So we have a ways to go at HUD to fully staff up and it's already September. HUD, like all agencies, have been focused on some cross agency directives that I think give you a sense of where they are focusing. There are time and energy with the staff who are there. This is mostly on deregulation. After coming out of a month's long hiring freeze, they're really focusing on where they can deregulate to save money, to save administrative time and we're a leading age putting recommendations in, but there's a fine line between deregulation and accountability. Because I can tell you as someone who's been on the hill for a long time, Congress needs to see and know where the money is going and know that their money is being well spent. And if you deregulate, we were talking about this this morning, you're not gonna get the cash back in your pocket because you made yourself so efficient. You're going to deregulate yourself out of a budget. So we are really watching the regulatory reform process. Really carefully, we're participating in it and know that all housing organizations that receive any money from HUD are being asked to streamline and strip down, which is all good and we want the programs to be as efficient as possible. But there's a point at which we have to make sure that we have the regulations in place that we need. For example, we have regulations. Right now, President Trump has said for every one regulation they issue, two have to be abolished. But just last year, the housing community after maybe 12 years of work helped pass a huge housing authorization and policy bill in Congress which did probably a hundred different things across programs and we need regulations to put a lot of those victories in place, to streamline recertifications of fixed income households income, to improve medical deduction expenses, deductions. And without those regulations, if we have to take two away for everyone we do, we're really worried we're not going to be able to get these good regulations in place. And again, we need leadership at HUD to help us do that. Meanwhile, before Trump came into the president's office when he was a candidate, he campaigned on deeply cutting discretionary program spending. So he campaigned on cutting 1% of agencies budgets every year which cumulatively will just desecrate the agencies. So you can't cut and cut and cut and have any housing programs left. So we have a candidate Trump who came in and said this is what we're going to do to the agencies and then when the Trump's budget request was delivered to Congress this year, the formal one, we saw those cuts come out in paper. So the president asked for a 15% cut to HUD for FY18, the fiscal year that's about to start in a few weeks compared to the current fiscal year, 15%. So deep cuts, like a 30% cut to public housing, deep cuts to vouchers, about a 12 or 13% cut to the 202 program. In addition to the deep cuts, we saw some really mean policy proposals. Ones that would increase rents on residents. So HUD residents in general are extremely poor. Residents in 202 housing have an average income of about $13,000 a year. And so there were proposals in the Trump HUD budget requests to increase resident rents by considerable amounts to do away with deductions from their incomes that residents can currently take before they calculate their rent for medical expenses they might have. So we saw big increases to rents that residents pay. This is in their affordable housing, right? If you increase their rents so much, they won't be living in affordable housing. And then we also saw a huge rent increases just across the board freezes to owners, which I think is really unconscionable. So the rents to owners, to public housing authorities, naturally go up a couple of percentage points a year just to pay for staff, to pay for utility cost increases. And so to tell owners that they would be seeing none of those rent increases really seemed ludicrous when the HUD machine relies on its owners who actually provide the housing to provide the housing. This all came at a time when we had stopped building housing at all and we haven't built new public housing in decades. We haven't entered into new Section 8 contracts in decades. We, this chart shows you the red line that tanks down at the bottom. So the right shows you how the Section 202 funding just stopped flat out in 2011. We haven't built new 202 housing since those dollars in 2011. So all these things we're talking about, these huge increases in need and this desire to cut more has come at a time where we haven't even been keeping pace with what we have. Every year we talk about preserving what we have and we're gonna renew everything that's out there. When you look at the numbers, the reality is that we're losing ground even given the population that we have today. In 2005, 38%, let me start again, in 2005, 38% of very low income seniors who qualified for rental assistance because they're a very low income received housing assistance, 38%. 10 years later in 2015, 33% did. And yet I guarantee you, if you look at the press releases of the appropriators who approved those budgets and the presidents who signed those appropriations bills, it says we preserved all the housing. Somewhere along the way, because we're not preserving all the housing we have, we are losing ground. This summer, Leading Age started a Save HUD 202 campaign. This falls really at the footsteps of every other organization doing their own campaigns to save every particular kind of housing because every piece of housing is under attack. Going down Pennsylvania Avenue, a couple of miles to Congress, we hope to find some reasonableness. And we have, shockingly, in the housing world, at least for now, where the House and the Senate are in the midst of approving their own FY18 bills. They have rejected the 15% cut to HUD. They have rejected the rent increases to residents, the rent freezes on owners. Those are all really great things. On the 202 program, we actually saw a small increase in new construction funds last year for the first time in several years. And we are right now on the cusp, we think of getting authority to expand a really great HUD preservation program called RAD, or the Rental Assistance Demonstration for some of these older 202 properties. But once again, nothing's ever quite easy because we're faced with budget caps. Remember years ago, I think it was in 2011, Congress passed these budget caps and there's a crisis every couple of years and we can't pass the appropriations bills because we're under these caps and they have to stay equal for defense and non-defense. There has to be this parity. If we raise them or increase them, we have to do one for the other. The caps are back. The last budget cap relief deal we had was only a two-year deal. It expires the end of this fiscal year, FY17. And there's no deal yet for next year. Without a deal is this chart from the Center on Budget Shows that when that line goes down to the right, if we don't get a cap's busting deal, a cap's raising deal, we'll be spending the least we ever have on non-defense discretionary programs. At a time where need is going up and up and up for the programs who serve people like the seniors we're talking about today. And the caps are put in place, remember, to attack the federal deficit, right? We want to get rid of the federal deficit. We want to do away with it. We're going to get to zero. I think it's interesting because right now, this coincides with the time when Congress is digging in to its tax reform debate. We're interested in the tax reform debate at leading age in the housing team, mostly because of the great things we think could happen with a low-income housing tax credit through tax reform. But right now, they're arguing about much bigger things around what should the corporate income tax rate be and who's going to pay for it. Well, there are a lot of people in Congress who also voted for these budget caps to attack the deficit, who don't want to pay for these tax cuts. You just want to cut the corporate tax rate to 15 or 18% and not pay for those tax cuts at all. And so I think it's really telling who we're willing to spend our federal resources for if we move forward with a tax reform bill that really is a tax cut bill. But let me jump back to the low-income housing tax credit program. It is in the mix, as you might know, in the tax reform debate, there are bills in the House and the Senate that would strengthen and improve and expand the low-income housing tax credit program. The bill in the Senate would expand the housing credit by 50%. That would bring maybe 144 new units to Rhode Island every year, which is great. But as Barbara said, these are just steps in the right direction. We need lots of these little steps. We also think, though, that the tax credit bills in the House and the Senate will do a lot to help the tax credit program better serve extremely low-income people. So people with incomes below 30% a very median. And that's where the bulk of the need is. If that worst case housing needs report looks at people with incomes below 50% of median, when you look within that whole bucket, the people with the greatest needs are the people with incomes below 30%. And if we can do a couple of things that are in this tax credit bill to help how the tax credit can better serve extremely low-income people, that would just be tremendous. And so we're really working hard to get those tax credit bills passed. As you know, our voice is our most powerful tool. And I do think that we just take a moment and acknowledge the terrificness of Rhode Island's delegation. You all have been blessed with quite the roundup of champions, of people who seem to know what the right thing to do is. But stay on them. Your delegation is a pretty senior delegation. It's pretty powerful. And I know that they have your back. And I know that you call on them when you need to call on them. And Senator Jack Reid in particular, I'll say that he's always been there for housing programs. But his role right now is the lead Democrat on the Appropriations Subcommittee for HUD is really critical. And he's protected these programs throughout the year. But he really can't do that unless he knows his constituents have his back and know how hard his fight is. Because fighting to increase discretionary spending on programs like HUD, Homeless Assistance, 202, Public Housing, that is a tough rock for Senator Reid to push up at the Hill all the time. And anything you can do to constantly thank him and make sure he has your support is really, really important. I wanna just say a couple of things about housing as healthcare. I'll kinda preface it by saying somewhere along the way we got away from, it just became not good enough that housing is shelter, right? We had to start asking ourselves, what does it do for healthcare? What does it do for employment? What does it do for people's education? And how are they doing in school? And so that kinda just makes me angry that housing as shelter isn't quite good enough on its own but that's where we are. And we're also, no, we're at a point where housing as healthcare saves a lot of lives and improves people's health and it saves a lot of money, which maybe we could push back into more housing. So this first slide is really tiny and hard to read but basically it's saying that seniors in HUD subsidized housing are very poor. They're older than they used to be. They're older today than seniors in public housing or HUD assisted housing were 10 or 20 years ago and they're a very diverse population compared to the rest of the general population. And so they're an interesting population or a platform to talk about when you're talking about healthcare and serving seniors. Seniors in HUD assisted housing also are more likely to be more likely to be duly enrolled in Medicare and Medicaid. So again, another reason that they're an attractive population to look at and they're more likely than the general population to have five or more chronic conditions. Again, more reasons for health providers and housing providers to pay more attention to assisted housing residents. There have been, contrary to my grumpiness, a lot of great research over the last several years that looks at the absolute connection between healthcare and housing. We know that if you have an onsite service coordinator, residents in those properties have 18% lower chances of having a hospital stay during the year. 18%, like I bet on that, right? That's pretty good. We know through the SASH program in Vermont that I know we'll talk about more today later that with an enhanced service coordinator and a wellness nurse onsite, people's medical care cost growth slows by about $1,500 a year. We know that people are less likely to have to visit the ER, that if they do go into the hospital, they have shorter stays. These are all things that can happen when you pair healthcare with services. Leading age is doing a lot of work to look at the intersection of housing and healthcare. And I don't know that I have time to go through it today, but I'll say that a lot of it just boils down to are we reducing costs on the healthcare side and how do we figure out the smoothest way to pay for those services within the housing platform where you have a lot of residents who need a lot of services and you also happen to have probably the facilities to provide that care in them. I'm going to jump ahead here and tell you real quickly about this woman. This is a woman in Santa Barbara, California. And I heard about her story on NPR. She, the story was about parking lots and Santa Barbara has sanctioned a couple of parking lots within the city limits as safe parking. It's okay to park there, you can live there in your car, okay? This woman is on the Santa Barbara Housing Authority waiting list. She's been told her wait would be about another seven years. And... Safe parking? It is called safe parking. They've designated 115 parking spaces in church, county, and city lots where people can park safely overnight. So this is, you know, this is, reminds me of a reporter who called me years ago and told me she just toured one of those tent cities, right, and told me how nice it was and they had street names and they had bathrooms. And I said, no, you know, people don't live, people shouldn't, it's not nice for people to live in tents. It's not who we are as a country. The graying of America's homelessness is real. Homelessness among seniors contributes to premature aging. It brings accessibility challenges, right, for people who have difficulty with their activities of daily living. It makes it really hard if you're living in a car to access benefits you might need. And it puts people at great risk of institutionalization where they don't need to be. And I know a lot of what we're trying to get at here is choice and independence and being able to make your own decisions. You can't do any of that unless you have an affordable place to live. And so I just wanted to say that, you know, tents aren't housing. We know that housing is housing and housing ends homelessness. Housing ends worst case housing needs. Housing ends people paying less than on their healthcare and their food and their transportation than they might need to. And I'm glad you're all here today to keep exploring these issues. We've got a lot of work to do. I don't think I could be in the job I am. I'm a perpetual optimist. So I think, you know, because of this, right, we know that housing ends housing. That's all we need to know, right? And so let's just go forward and get it done. So thank you. Thank you, Linda. A lot of food for thought, obviously. And a lot of, and I know particularly for the non-housing people in the room, we threw out a lot of terms and terminology. We're not expecting us to each understand all of the terms but part of what we're trying to do next in the agenda is to do a little deeper dive. And so we have two sessions that we're gonna break up into the classrooms. And Christina, are you at the health session? So we have a healthcare 101, kind of a quick overview of anything and everything that you wanted to know about healthcare. And our great friend Joan is going to be leading in that session. And then on the right-hand side in the classroom on the other side, we're going to do a housing 101 session. So you can pick and choose which session most fits your need. And our friends from POA, Corey and Kathy and myself will be in that session as well too. So I'd ask you to grab some coffee, use the facilities if you need to and go to a room. And then we are gonna come back here at 315 for a closing panel and some discussion around next steps. Thank you.