Affordable Assisted Living for Low-Income Seniors

Carla Pope, Program Manager, Coming Home Program, Iowa Finance Authority

Photos by John Gaps

Carla Pope began campaigning for her job directing the Iowa Coming Home Program in Des Moines even before the state landed the Foundation grant that funded it.

"This was something my heart was in," says the 42-year-old Des Moines resident.

The "something" is a challenge many people would shy away from: finding a way to bring together disparate local, state and federal agencies with public and private developers to create affordable, assisted living residences for low-income tenants in a rural state where one in four elderly residents have monthly incomes at or below $884.

But Pope, who has spent her career working in health care, much of it in the long-term care arena, is not one to back away from a challenge.

Her colleagues describe her as a woman who is "not intimidated by the unknown," who "welcomes challenges" and who sees no alternative to a successful project.

Indeed, just two years after landing her job running the Iowa Coming Home program at the Iowa Finance Authority, she has managed to get six demonstration projects going. The first one, Emerson Point, opens in 2003 with 54 apartments. That's six demonstration projects, when the original grant called for five. "Guess I'm a bit of an overachiever," she says.

And more than just a bit passionate.

Ask her why it's so important to provide this kind of housing for poor elderly and she quotes a National Academy on Aging finding that just 7 percent of older men and women with long-term care needs who have family support are living in nursing homes compared to 50 percent of those who have no family support. "I don't want to see a nursing home viewed as a housing option," she says. "I want to see it viewed as a health care option. There should be other housing options out there for people who need some services but who don't need skilled nursing care."

Seeing the Issue Firsthand

Growing up in Nebraska ("almost like Iowa,") Pope was close to both sets of grandparents. One set went into a private pay nursing home, while the other had to make do with a hodgepodge of home care. "The experiences for the two were significantly different," says Pope. "So even at a very young age, I recognized that access to money significantly molded what your experience was going to be as you got older."

That understanding deepened when her father died after a lingering illness that required long-term care. Her intimate involvement with his care made her realize that her father's options would have been significantly limited, if her parents had not had money. "(The system) was frustrating to deal with even with the money," she recalls. "I couldn't even imagine what it would be like to try as a person without resources, who is sick, to go from government agency to government agency to try to receive help."

That's precisely the kind of scenario she's working to help prevent.

Coming Home is a national program of the Robert Wood Johnson Foundation in partnership with NCB Development Corp. in Washington, D.C. The program provides grants, technical assistance, and loan funds for states to create affordable models of assisted living that target low-income seniors and are linked with existing community health care systems. The Iowa Coming Home program provides technical assistance to developers and service providers to create affordable, assisted living facilities; makes recommendations to state and federal policy-makers on how they can support the growth of affordable assisted living and provides a predevelopment loan program to nonprofit sponsors of affordable assisted living for low-income seniors. Pope is the one tying it all together.

When she started working for the program, the state had 120 assisted living programs, and few served Medicaid clients. "I just believed in my heart that we could do better," she said.

Today, she juggles an alphabet soup of state and federal agencies and public and nonprofit organizations, including three trade associations, the public health department and economic development and finance authorities across the state.

"I refer to Carla as having the 'big picture' because she is the one who has a general knowledge of all the programs and services necessary for a successful affordable assisted living," says Kathy Winter, public housing revitalization specialist, who works with Pope through the Iowa HUD office. "Typically, there are practitioners of various specialties at these meetings, and Carla has been able to bring it all together."

Or, as Robert Burns, the private developer who is building Emerson Point put it: "When handed lemons, she not only makes lemonade, but also invites others to bring potato salad, hamburgers, brownies and fireworks. She turns it into a party to which, of course, low-income, frail elderly are invited to share in the opportunity and to combat isolation. The excitement over what is now available makes everyone forget the day we started with lemons!"

Among her victories:

  • initiating three grant applications to pay for conversion of an existing HUD-funded or affiliated property to be physically converted to meet state regulations for assisted living
  • working with the Iowa Finance Authority to establish an affordable assisted living set-aside in the low-income housing tax credit program
  • more than doubling the number of market rate assisted living programs that participate in the Medicaid waiver from 16 to 46 during Coming Home's first year.

As one colleague described her: "Carla is very much like the World Wide Web. If you don't already know Carla, you soon will."

Focus on the Customer

I am an 83-year old widow. My only income is Social Security, about $700 per month. When my husband was alive we did pretty well with his pension and Social Security, but since he died five years ago it has been so difficult. I have trouble getting dressed each day. I had a stroke two years ago, and my left arm doesn't work like it did before. The home health care agency sends a home care aide during the week to help me get dressed, but I have no one to help on the weekends. My son, who lives three hours away, is afraid that I will fall and no one will be there to help me. He wants me to move, but where can I go on $700 a month? It all seems so overwhelming and confusing to go from one agency to another asking for help. But the thought of moving to a nursing home is so depressing -- the only person I have shared a room with is my husband.

It is stories like that—and the people behind them—that keep Pope motivated. She has carried that focus on the customer throughout her career. As director of assisted living for the Iowa Health Care Association, where she spent much of her time as an intermediary between government entities and providers, she stressed the importance of putting the customer's interest first. "That was my strength; that I would always focus on the customers. The customer was something regulators and providers could agree on and so we used it as our basis for going forward."

That's why the job with Coming Home appealed to her so much. "I have to believe in what I'm doing," she says. "And I wanted to work in an area where the sum of our work could be bigger than the parts and would have a lasting impact on the health care environment."

She appears to be doing that now. If Emerson Point, the first facility to open, is successful, it will save an estimated $800,000 annually in state and federal funds, not to mention providing 54 people with bright, new, one-bedroom apartments complete with full kitchens. The complex already has a waiting list of 40 people hoping for spots, some from as far away as South Dakota and Minnesota.

Seeing that project come to life, Pope says, has been "incredibly exciting." "We've been working ourselves to the bone for two and a half years," she says. "Now all the blood, sweat and tears are coming to an end and we're finally getting to serve people."