BY: ROBERT WILLIAMS
Mr. Williams is administrator, Mercy Special Care Hospital, Nanticoke, PA.
Catholic Health Care and Social Service Organizations Teamed Up to Construct
Housing for Seniors
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SUMMARY
Through collaboration, Mercy Health Partners (MHP) of Southwest Ohio,
Cincinnati, and Catholic Social Services (CSS) of the Diocese of Scranton,
PA, built a housing complex for low-income seniors and developed a variety
of supportive services for residents. St. Catherine's Manor aims to meet
elder adults' social and medical needs through offerings such as on-site
health assessments, meal services, and transportation help.
In order for the collaboration to be a success, MHP, CSS, and their partners
had to trust one another. They also had to be clear and deliberate about
their roles and responsibilities, thereby establishing expectations well
in advance of the project. Their partnership was enhanced because they
shared a common culture.
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Growing old used to be less complicated than it is today. In the past, senior
citizens usually resided with or near their children and other members of their
extended family. Social Security helped offset the bills. Major health problems
might have required a hospital stay, but minor ones were taken care of by the
family physician, who made house calls. Counseling, when sought, was done by
one's pastor. People tended not to live as long as today and usually died at
home.
In the mid-1960s, with the advent of social programs such as Medicare and Medicaid,
health care was expanded to include visiting nurses, medical equipment in the
home, and nursing home care. More funding became available for social service
agencies. Legislation such as the Older Americans Act of 1965 gave birth to
Area Agencies on Aging, Meals on Wheels, and similar programs. As a result of
improved nutrition and health care, among other causes, people began to live
longer. Two-income families became the norm. The nuclear family splintered,
producing fewer children and more divorce. The once-crowded family home is today
often inhabited by a single senior burdened with medical problems, housekeeping
duties, loneliness, and creeping impoverishment.
Programs have been created to help less-affluent seniors. The Program of All-inclusive
Care for the Elderly, adult day and senior centers, prescription drug assistance,
and family medical leave for caretaker children—to some extent, these provide
the care once furnished by the extended family. Unfortunately, coordination
of such elder-care programs and agencies is often absent or inconsistent.
However, consistent, coordinated care is a hallmark of St. Catherine's Manor,
Dunmore, PA.
St. Catherine's Manor
St. Catherine's is a 60-unit housing project for people aged 62 and older.
Developed by Catholic Social Services (CSS) of the Diocese of Scranton, PA,
and Mercy Health Partners (MHP) Northeast Region, Scranton, it sits on 5.5 acres
of land in a suburb of that city. St. Catherine's is a two-story, colonial-style
facility overlooking a lake. It has 50 one-bedroom units and 10 two-bedroom
units. Six units are wheelchair-accessible and three are equipped for the hearing
and vision impaired. Five percent of St. Catherine's nearly 47,000 square feet
is community and common areas. All units have fully furnished kitchenettes and
showers equipped for the handicapped.
A county-sponsored bus provides transportation to and from St. Catherine's
front door. St. Catherine's was the first housing project in Pennsylvania to
offer a service-enriched model of care that meets senior's social and medical
needs under a single roof.
Not an assisted-living facility, St. Catherine's attempts to provide the supportive
services needed by elderly people who, though frail, are in general good health.
The site includes a fully equipped medical examination room for a nurse practitioner
who visits several times a month. During these visits, which are funded through
MHP's Community Health, a community-outreach program, the nurse practitioner
takes residents' vital signs, monitors their blood glucose, and makes physician
referrals for residents who need medical care.
A podiatrist visits St. Catherine's frequently to provide residents with foot
care. Health educators come to present in-service sessions. A social worker
from CSS conducts ongoing individual needs assessments. If they choose, residents
can arrange privately to get help with light housekeeping, laundry, meal delivery,
nurse-aide services, and bathing and other personal care needs. St. Catherine's
has a building manager on site daily.
Financing the Project
Although Catholic social services agencies and health care providers have
always shared a common vision, close collaboration between them is a fairly
recent phenomenon. Before creating St. Catherine's, MHP and CSS had collaborated
on a few small projects—for example, meal services to the homebound, employee
assistance programs, and health prevention and promotion programs—in northeastern
Pennsylvania. But they had attempted nothing of the magnitude of a multimillion-dollar
affordable-housing project.
However, it became clear that many of the region's low-income seniors needed
such housing. In 1998 the leaders of MHP and CSS began meeting to discuss what
their organizations might do to meet this need. They decided to construct a
housing development that would, for an affordable price, allow seniors to maintain
their independence in a homelike setting that also met their social and medical
needs.
The partners' common culture allowed them to work together smoothly. The Sisters
of Mercy have been present in northeastern Pennsylvania for more than 100 years.
As part of Catholic Healthcare Partners, Cincinnati, the congregation currently
cosponsors three area hospitals and a number of community health entities. CSS,
which is part of Catholic Charities USA, has been active in the area for nearly
75 years. A key project planner was CSS's director, Steve Nocilla, who had experience
with the Low Income Housing Tax Credits (LIHTC).* Nocilla had earlier led the
rehabilitation of two housing facilities for low-income people. LIHTCs, administered
by the U.S. Internal Revenue Service (IRS) in conjunction with state agencies,
are allocated to each state at the rate of approximately $1.25 per resident.
The agency in this case, the Pennsylvania Housing Finance Agency, administers
about $20 million in LIHTCs annually.
*For more on the Low Income Housing Tax Credit, see Chuck
Wehrwein and Melinda Pollock, "Health,
Housing, and Public Policy."
LIHTCs are awarded to housing developers and their investors as incentives
to construct housing for people who otherwise could not afford it. St. Catherine's
cost of construction was estimated to be $6 million. In return for investing
$3 million in the project, St. Catherine's chief investor will receive tax credits
spread over a 10-year period. The Pennsylvania Housing Finance Agency will monitor
the project to ensure that income requirements are met and that the building
is well maintained, reporting any instances of noncompliance to the IRS.
In addition to the tax credits, St. Catherine's benefited from several "groans"—grants
that become loans only in the event that prearranged conditions are not met.
These include $1.5 million from Penn Homes, a Pennsylvania Housing Finance Agency
subsidiary; a Community Development Block Grant of $200,000; and $480,000 from
the Federal Home Loan Bank, a deferred developer's fee, and a short-term loan
from CSS. From this patchwork of sources the $6 million necessary to construct
St. Catherine's was brought together.
Trust Is a Necessity
A collaborative project like St. Catherine's requires trust and mutual respect
from the partners. CSS's and MHP's leaders began their partnership by discussing
the skills that each organization would bring to it. On its side, CSS provides
services for the poor and elderly, case management, housing assistance, and
other programs in northeastern Pennsylvania. MHP offers the region's widest
variety of postacute services, including inpatient care, outpatient care, skilled
nursing and long-term care, home care, and hospice care. Community Health offers
pastoral outreach for the homebound through local churches and synagogues. Health
Quest, a community-outreach program for seniors, has more than 20,000 enrollees
in the region.
Legal assistance was necessary from the start. Two law firms were engaged to
perform a variety of tasks, including overseeing the land purchase; forming
the corporate entity through which CSS and MHP would share ownership of St.
Catherine's; and dealing with county administrators, housing agencies, and social
service directors, all of whom required a memorandum of understanding or contract.
Stacked together, these documents are about a foot high.
The creation of St. Catherine's proved to be an education for CSS's and MHP's
leaders. They learned a good deal about negotiating with local planning boards
and state and federal funding agencies, for example. Such organizations do not
always give one a lot of time to complete applications. Missing deadlines or
not having the necessary information can delay a project for months, at the
cost of thousands of dollars. CSS's and MHP's leaders also learned that, in
collaborative arrangements, duties should be spelled out clearly and concisely.
In a project like St. Catherine's, a fear of stepping on toes or holding people
accountable can be disastrous. Promises made to complete a task on schedule
must be kept.
St. Catherine's Is Completed
To be eligible for LIHTCs, a developer must promise to limit for a period of
30 years the rent charged for some of the housing units developed. St. Catherine's
developers planned 12 units to be rented at 40 percent or less of area median
income, 25 units at 50 percent or less of median income, and 23 units at 60
percent or less of median income. This average unit rent would be approximately
$139 a month.
Construction of St. Catherine's began in April 2001 and was completed in January
2002, nine months later. During this time, the project's planners met every
other week to discuss everything from color schemes to the quality of workmanship
and the approval of invoices. A representative from the Pennsylvania Housing
Finance Agency attended each meeting. (When one deals with funding agencies,
meetings, audits, regulatory reviews, and the completion of forms becomes part
of everyday life.)
The Lackawanna County, PA, Housing Authority was engaged to manage St. Catherine's
and advertise for potential residents. The first resident was admitted in January
2002. Currently, St. Catherine's has a nine-month waiting list for apartments.
Most residents are women; their average age is 76. The highest monthly rent
paid is $287 and the lowest is $3; the current average is $139.
CSS's and MHP's leaders sometimes ask themselves: Would we do it over again?
Their answer is yes, without hesitation. But, they are quick to point out, without
their two organizations' collaboration and without the assistance of many others,
St. Catherine's Manor would have never materialized, and the community would
have one less housing choice for low-income seniors.
Copyright © 2005 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.