The future of aging and our country going forward, particularly on the housing end. To begin because in doing some research for the sides getting to know my panel, i rediscover the founder of aarp and i will give s plug because dr. Andru was extremely concerned about housing for seniors and creaking livable communities. That is back in the 50s. I did not know and many of you might not know that she actually started one of the First Independent living facilities for seniors in california called the grey gables. Their principle was that seniors should have environments that allow them to continue to contribute to their communities. We are not all problems. We are also vibrant contributors to our neighborhoods and communities. Whicharted the acacias, is a Skilled Nursing facility. This is back in the late 50s. She developed a design for the freedom houses or house of freedom and she did a ribboncutting with president eisenhower in 1961, showcasing the house of freedom, which incorporated a lot of visibility features and universal design features that we have heard talked about today. Some of the solutions have been with us a long time. It is not too late. We need innovation because our current economic climate. There are solutions. It is never too late to begin. With that, were going to begin. To give you an idea of our format, i will ask the panelists questions about their work and what they have identified as best practices and what some of the gaps are in a couple of other questions about what is happening now which is positive and solutionbased and we will take questions from the floor. I will begin with assistant secretary greenlee. Theave heard lots about current and impending Housing Needs and challenges for the 50 plus population in our community. This includes the need for affordability, assess ability, connectivity, and housing and longterm care. , can you tellork us that you have identified at the federal, state, and or local levels, some the best practices and policies for addressing some of these challenges . I wanted to start by noting the secretary. Your comprehensive overview is so impressive. Of all of the issues and innovations around the country, you have really done such a wonderful job in your overview. Id like to start in left field and announce this before our business. [laughter] why do people move from their home . What we pay for it when we move from it . We take a room and board. The concept when talking about housing and services may feel like a new part of this great big world, this housing. [indiscernible] to weoint, we need will pay for what ever. Program icaid [indiscernible] even that [indiscernible] [inaudible] at some point, you need someone who is going to go between the persons and that is what we are trying to do. One person, whether or one person who has a community in america will really help someone. [inaudible] [laughter] this is a really [inaudible] i did not turn it on . [laughter] even though the policies today are [inaudible] all of the planning can come that, the if you do nt of this is to reach out [inaudible] [laughter] i did not mean you. I meant me. Lindsay, you are actually to the agefrom the community started at the Grassroots Level with seniors themselves being involved in the process. Can you tell us a little bit about what you have learned that is working well with the agefrom the community in new york . Agefriendly new york city was started around 2007. It is a partnership between the new york academy of medicines and new York City Council and the office of the mayor. To look at all aspects of city life to see where improvements to policies, practices, and aograms can really make difference for older people in maximizing their participation in society. Used theave done is World Health Organization framework for active aging, which identifies a domains of an agefrom the community. One of which is housing. We work across those domains. The first step is a was to go straight to the source. Older people themselves. We do this through Community Consultations in focus groups and surveys, and we ask older people exactly that question that you just hose, which is what do you do all day . What is your daytoday life like . What you like about your community . What do you like about your housing . What do you not like . What are the barriers that may present you from being as involved as possible . And then we bring all of the relevant sectors to the table. Along with the older people to collectively dratted tries Creative Solutions collectively strategize Creative Solutions. I am talking about the housing the nonprofit and faithbased sector, culture, transportation. We operate according to the premise that you can actually flow or reverse the disability trajectory by modifying the the social, environment, economic environment, and physical environment in addition to certain lifestyle changes. Think that we see older people rightsbased rather than a needsbased perspective and we see older tenants and homeowners as assets to communities. Often longterm residents are among the most cynically engaged, have a real, comprehensive understanding of their communities assets and vulnerabilities. For this this is a good story. Or us, this is a good story. I cant get into specifics later, but what has been essential is we have the right people around the table and that we not delegate the issues of older adults in the housing to one Government Agency like the department for the aging, but rather we see this as everyones issue. It is an issue for all sectors, all government agencies, and we bring those people to the table. We have done this at the macro level across the city and we do it in more localized ways. We go by committee district. The strategy has produced incredible results to really improve the quality of life for older new yorkers. Could you give us an example in the housing arena of how having the right people with the right stakeholders at the table has led to success . Absolutely. I love that you touched on the doorman issue. Locale partnered with 32bj which is the Building Service workers union. They have about 50,000 members. What they have done is really taken this up as their issue. They have created a training that is part of the career ladder for their members. Porters and other kinds of Building Service workers learn about the needs and assets of older people, specifically how to identify signs of older use, signs of cognitive decline in that. Identifysufficient to subtle changes that occur in an individual over time. Tohave empowered them provide assistance and to know where they can refer the tenants when they start to notice certain troubling signs. Now we have actually expanded that program to include a module on the needs of older people in disasters. We found that during Hurricane Sandy that Building Service workers were essential in meeting the needs of their older tenants. Great. Thank you. Im going to move on to you, terry. I know you worked in new york but also across the country. Maybe you can tell us i think that you enterprise does a lot of work and assisting developers and Nonprofit Developers produce housing, correct . Theyou tell us, what are best practices and policies that you have discovered actually help address some of these housing issues that we have discussed so much today . As a starting point, enterprise is a National Organization that looks at safe and healthy housing as a fundamental platform for delivering opportunity. It is mostly the first rung on the ladder of opportunity. We intentionally try to look at connecting housing to health care to education to jobs in transit. That is very much what we believe, as our theory of change, if you will. In our work, what we found is that those critical intersections between today many of those intersections that health and housing are so fundamentally important. What we try to do is look at the needs, starting with what does the resident need, what are the needs of that older american that is there . We are a working across a variety of age ranges. We also think about the system change that we are trying to embrace, but from that perspective. Were looking at a spectrum of services. To give you a sense of that, we are starting with a building level look and we are looking at what does it take to get that building constructed, the financing, the design, the construction, all the way through to one of the services needed . We are looking at that whole piece and some of the things we , all of these things have to work together. At the building level, we have a yougn practice the how do build a design level that is appropriate. How do you build housing with mind, within disasters but also in the frame of daytoday . As we look we know the financing models. It was a fantastic keynote. Certainly henry suggested the shortage of resources. We have to learn to leverage resources earlier. One thing we have to manage is how it makes those financing streams and what we are seeing is developers are becoming better at mixing the housing and financing strains with some of the other financing strains like coming out of medicare, medicaid. A lot is happening at the state level. We are seeing a lot of this happening. I think that the developers who work with understand the criticality of that. At the end of the day, i also think that one of the most important things that we have been able to do is to look at there is a lot of fragmentation. There are two big things. One is how do you drive those cross sector conversations and break down the silos. The second thing is there is a lot of fragmentation. One of the things we did a number of years ago is to introduce enterprise agreeing communities criteria. It basically said there are a lot of ways we can look at sustainability. How do we look at water efficiency, energy efficiency, bringing that together . We have taken that criteria and start to say, what else should we do to help create a Common Ground for developers to look at how they can develop housing so we can influence that process . Taken thate, we have enterpriseagreeing communities criteria and expanded it to include siding. Where is housing getting built relative to transit . Universal design. We have a whole segment on universal design. That is significant because you build that set of criteria into the policy mechanism where incentives are. In developing Affordable Housing, we know the loans and housing tax credit is the biggest driver. A location in tax credits are awarded at the state level to our allocation process. We now have criteria embedded about 25 states. Is to saystarts to do if you made this set of criteria say universal design you score better on that incentive. You take a capital flow and look at it in a new way. What can we agree upon . How do we innovate and be open source about that, taking into the needs of our developers, the needs of the residents, and start to put things we can agree to and start to drive and capital flow . It has been meaningful work and what were finding is we need to adopt that work but we are very opensource about this. We are doing most of this with our partners. Many of them in our are in the room today. Were trying to evolve the work and think about what are the policy mechanisms, capital flows, and local solutions that are needed . The universal design criteria that is in the qaps that you there, ied to get in would imagine that is an important education process to stress and get the local funders to adopt to state housing agencies or entitlements to adopt criteria that reflect an understanding of how important these design features are. Absolutely. We started out with seeing those optional but it is a pathway for them to achieve certification. It means they are more entitled to those incentives. That is a huge education process. We are finding a lot of energy and excitement about this, even though it is optional. It is opening peoples mind saying this is a good way. This is a smart way of building. Processhuge education and we are learning as an organization from our work that we did with many folks on the sustainability side is that if you really want a healthy home, this is also a way the Green Community can encourage a healthy home. We are dealing with asthma from the onset, we are dealing with critical issues. We had some tough love in learning how to take that and really make that practical. We have a lot of those lessons. We had to learn with Asset Managers that are running the buildings and boilers and try to figure out or the residents themselves. How do you take a set of practices and make them work . We are doing the same thing with universal design. How do we smartly innovate around that . That is wonderful. Of ou thought about one about what the best practices and policies are that you have seen that enable communities to meet its needs . Is actually fortunate for the Aarp Foundation to see the breadth of the best practices. We can focus on the low income which can be challenging, but we are seeing innovations happen. Having been in philanthropy for many years, there are many silos in this area. The connection of conversation is critical. How do we engage the Housing Community to interact more with the health care community, transportation sector, and other sectors. Enterprise is a great example of how this is happening. Best practices that i want to share with you is coming out of vermont. Enterprise, at a learning collaborative, and invite you to visit our website. It looks that demonstrated models across the country that are working. I think the issue to remind ourselves is that the our state and local issues. To have a National Best practices is not going to be the case. It will be a lot of models that work in different communities. Inman, the fetal scare , they havein vermont been working with administrators across the state to coordinate care and providing it will miss nurse in addition to the housing and the program is called sash. It is a nascent program. It is part of a man valuation. We are helping it is part of an evaluation. Guide helping to create a that will be a dictionary for help and housing to come together. Before this conversation, you are speaking the language. That is one of the challenges. I was in a meeting and they were talking about health care. There were using acronyms and people raising their hands. Cbg and talking about other housing acronyms, you do not understand either. As we look at connecting the systems, we have to start with the basics. That is one of the things the learning collaborative is doing. Cathedral square in vermont, i think one of the criticisms is vermont is unique. Howl you translate that . You look at the pieces of that. There is other work as well. It is going back to listening to residents, listening to what their needs are and how do we connect those services to their housing . Mentioned some great things that are working well. Some of the factors that need to be in place. What do you cs some of the major gaps . What are we missing . Thatdo we need more of only address issues of conductivity but affordability . We have heard a lot about the particular needs of lowincome renters. The housing shortage, the lack of sufficient subsidies to keep housing affordable. What would you say are a few of those gaps . Is it just money . We are talking about new housing built. Is a Community Awareness . Political will . All of the above . I will put a plug in for rental housing. I think the data shared with us this morning speaks to this as an emerging trend. When we talk about diverse markets and minority communities, they have higher rental indices. Looking at the need for rental housing, it has been a successful model. To build housing, how do we have more like that . The need is very expensive. Committeesncense that were housing is a big gap. I could not agree more. I would build on that, which the the importance of bringing in the private sector cannot be overestimated. We all know there are incredible shortages. Housing credit that has worked well is a publicprivate partnership. I think what we are seeing is the half empty view, that there is simply not enough resources. The halffull view may be that we are seeing interest in private sector players that come in and they say, how can we help . They see housing as a critical intervention. I like to quote one my Board Members who runs childrens healthwatch. Housing is a vaccine. Doctor, i havea got to have a safe and affordable, healthy home for a child to go back to. The same with older adults. It is a vaccine. We are starting to people in the Health Care Sector invest in low income tax credits. United health care has been an investor and are helping us with pilots in texas for developers to say, i have a Texas State Health plan. I can help deliver services in a communitybased way. They are not only investors from there into the financial books. Not just to get marketrate returns. They are getting interested in the issue and bringing practice alongside those investments. I think that is huge. They are just one example. That leads us into the issue of health. Yes. Was that a question or [laughter] we have been there all day. The gaps that you think we have that we need to fill to make better progress on this issue, whether they are policy gaps or practice gaps . Is it just money . Is a crosscollaboration . Community resistance . From the federal level, what would you say . Is possible this will be my glass halfempty part. Do ank as a nation, we can better job of talking about the continuum. Im not talking about levels of care. Longtermuum between care and communitybased care. Part of the trouble with health is that we are too isolated in older adults when there are acute episodes and crisis episodes and not sufficient conversation about the longterm support health care is part of communitybased organizations. They are not necessarily viewed comprehensively. One of the right investments we need to make all along the way. We tend to focus too much as a the escalating healthcare cost, which is clearly an issue we need to address. For older adults, life happens between these crisis incidents. That is not addressed comprehensive enough. Part of what we have been able to do is invest more in eviden