Fishers Advisory Committee on Disability

CITY OF FISHERS AGENDA In accordance with the Americans with Disabilities Act (ADA), the City of Fishers will, upon request, provide appropriate aid (i.e. interpreters) and/or assistance leading to effective participation for people with disabilities. Anyone who requires such assistance should email Kelly Lewark, Office Manager, no later than 48 hours before the scheduled event or call at (317) 595-3487. The public may stream the meeting online. Members of the public may submit comments online before 12pm on Monday, January 1, 0001. BOARD/COMMISSION: Fishers Advisory Committee on Disability Meeting DATE: 4/11/2023, at 5:30 PM DIRECTIONS: Fishers Pavilion Conference Room, 10 Municipal Drive, Fishers, Indiana 46038 1. Call to Order / Roll Call 2. Approval of Previous Minutes a. December 6, 2022 (Voting Item) Document 3. Guest Speaker(s) a. Future Recreation Center - Jacob Reardon McSoley, Director of Recreation and Wellness 4. March Disability Awareness Month 2023 Overview a. Snapshot of Kickoff Keynote Presentation – Kelly Hartman b. Award Winners and Highlight of Events – Cecilia Coble Page 1 of 46  c. My Point of View Day Debrief Transportation – Cecilia Coble Housing – Wilbur Sutton Employment – Chrissy Pogue & Michelle Steltz Community Support / Services – Kelly Hartman Recreation / Arts & Culture – Shelby Slowik Networking / Social Opportunities – Darcy Keith Mental Health – Stacey Oldham 5. Staff Communication a. Accessible Housing Guide + Accessible Housing Study – Ross Hilleary Document 6. Announcements a. State of Indiana General Assembly Resolution – Cecilia Coble 7. Adjournment Page 2 of 46  CITY OF FISHERS FISHERS ADVISORY COMMITTEE ON DISABILITY LAUNCH FISHERS HUSTON THEATER MINUTES December 6, 2022 The meeting of the Fishers Advisory Committee on Disability convened at 5:30 p.m. A roll call was taken. All Members present: Cecilia Coble, Kelly Hartman, Wilbur Sutton, Stacey Oldham, Darcy Keith, Chrissy Pogue, Michelle Steltz, Shelby Slowik and Ross Hilleary. Also present: Megan Vukusich, Jennifer Pope, Kay Prange. Mr. Sutton made a motion to approve the September 6, 2022 meeting minutes, seconded by Ms. Keith. The motion passed 9-0. 1. Guest Speaker a. Jennifer Pope, Fishers High School Department Head & Teacher, Exceptional Learners Jennifer Pope of Fishers High School presented the Tiger Tough program, which awards two $500 scholarships through HSEF. She is looking for ideas and opportunities and possible expansion to HSE. There was discussion about academics, clubs, extra curricular activities. The money can be used for textbooks, tutorials. Next steps would be to present it to the school board and also post to the Fishers Web page. 2. Committee Updates a. 2022 IHCDA Lt. Governor’s Excellence in Affordable Housing Award – Urban & Special Needs Housing Award (SouthPointe Village) RealAmerica Cecilia Coble announced the Awards and noted it as a proud moment. Kudos to Wilbur Sutton! b. Accessibility & Transportation Stacey Oldham spoke about accessibility in Transportation and the research that has been conducted with Green Bay, WI as a model. They established a Transit Authority using local and federal funds. Who holds the funds that are allocated to Fishers? The FACD has no authority to make decisions on this topic. c. Housing Wilbur Sutton visited Turnstone in Ft. Wayne and was impressed. They are exploring land trusts and other opportunities. d. Employment Chrissy Pogue and Michelle Steltz spoke about the Reverse Job Fair which was very successful. The next one will be in October 2023, National Disability Employment Month. e. Community Supports & Services Kelly Hartman spoke about Hamilton County and the lack of staffing for Community Support and Services. The new Legislative session is a long session budget year. Lobbyists will engage in formal advocacy efforts. Buttermilk Mountain employs all special needs folks. Support is received politically from Todd Houston and Suzanne Crouch, Lt. Gov. f. Recreation/Arts & Culture Shelby Slowik spoke about programs at Conner Prairie. The Team for Arts and Culture includes Ross and Samantha. g. Networking/Social Opportunities Darcy Keith discussed Networking/Best Buddies. She is getting a list of social groups together. Page 3 of 46  3. Staff Communications a. Accessible Housing Guide Draft Megan Vukusich and Ross Hilleary presented the 1st Draft of the Accessible Housing Guide. Waiting on data from the FSSA. Higher density development will help meet the demand for the aging population. Cecilia noted that we need examples of other development in the state. 4. FACD 2023 Meeting Calendar – A Motion to approve was made by Mr. Sutton and seconded by Ms. Hartman. The Motion was approved, 9-0. 5. Fishers March Disability Awareness Month 2023 – Building Our Future Together (Save the Dates) a. MDAM Kick Off, Wednesday, March 1, 2023, Launch Fishers, 8:30 AM b. MDAM Art Reception, March 3, 2023, Conner Prairie, 6:00 PM c. Fishers Arts Council Reception, March 10, 2023, Art Gallery at HCCF, 6:00 PM d. MDAM My Point of View Day, Thursday, March 30, 2023, Launch Fishers, 8:30 AM 6. Fishers Advisory Committee on Disability 2023 Inclusion and Accessibility Awards a. Now open and accepting nominations for Life Without Limits, Cornerstone Employer, and Accessibility Awards, until January 13, 2023. Selection is January 17, 2023. 7. Adjournment - The meeting was adjourned at 6:45. Next Meeting: Tuesday, April 11, 2023, 5:30 PM at Fishers Pavilion, 10 Municipal Drive, Fishers, IN, 46038. Page 4 of 46  ACCESSIBLE HOUSING GUIDE Fishers Advisory Committee on Disability Alt Text Image 1: City of Fishers, Indiana Logo March 2023 Alt Text Image 2: A three-story grey brick and masonry multi-family apartment building with a glass front door. Page 5 of 46 ACKNOWLEDGEMENTS Mayor Scott Fadness City Council John Weingardt, President Cecilia Coble, Vice President Brad DeReamer Crystal Neumann Pete Peterson Selina Stoller Jocelyn Vare Todd Zimmerman Fishers Advisory Committee on Disability Cecilia Coble, Co-Chair Kelly Hartman, Co-Chair Wilbur Sutton Stacey Oldham Darcy Keith Chrissy Pogue Michelle Steltz Shelby Slowik Ross Hilleary, ADA Coordinator Staff Megan Vukuisch, Director of Planning and Zoning Jonah Butler, Senior Planner Special thanks to: Urban Partners Insights ViaQuest Community Solutions Cover Image 2: Ritchey Reserve Senior Living Courtesy of RealAmerica LLC. Page 6 of 46  Accessible Housing Guide 3 EXECUTIVE SUMMARY In 2022, the City of Fishers Advisory Committee on Disability commissioned Urban Partners, a leading economic and planning analysis firm, to put together a report on the demographics of Fishers residents who live with disability, and the availability of accessible housing (whether assisting living, group homes, or designed accessibly) within the City for said residents. This report, alongside a similar report commissioned by the City analyzing future housing needs in 2021, recognized the increasing demand for, namely, senior and elderly assisted living, active lifestyle, and universally-designed housing projects. In anticipation thereof, this Guide provides resources for those living with disability (now and in the future), real estate developers, and non-profit organizers interested in ensuring the recommendations of the Accessible Housing Study are actualized. A summary of the Accessible Housing Study findings is below. The full report can be found in Chapter 9. Demand Analysis As of 2020 it is estimated that 7.0% of the City of Fishers residents, representing 6,572 of the City’s 93,356 population, reported having a disability. This includes six categories of disabilities including hearing, vision, cognitive, ambulatory, self-care, and independent living. In the City of Fishers, 2.9% of residents report cognitive difficulties, 2.5% ambulatory difficulties, 2.2% hearing difficulties, and 0.9% vision difficulties. To estimate the Fishers population whose physical, intellectual, developmental, or mental health condition may require accessible housing and/or daily residential supports. Urban Partners used the Self Care and Independent Living criteria from the American Community Survey. These criteria are used by health care providers in making care recommendations. This same methodology was used in the 2016 Myers & Stauffer report for the Family and Social Services Administration (FSSA). As of 2020, it is estimated that approximately 1,458 Fishers residents have activity limitations significant enough to merit residential accommodations and/or supportive services. The Accessible Housing Report acknowledged the importance of determining a person’s ability to pay for necessary housing accommodations and services. The report found that the prevalence of poverty in the City of Fishers among the population without a disability is three to four times lower than within the disabled community. Children and adults aged 18-64 with a disability experience the greatest level of poverty (8.0%), with the poverty rate of the elderly population with a disability appreciably lower (1.7%) The availability of state and federal benefits geared towards seniors, regardless of disability status, likely contributes to the lesser incidence of poverty among Hamilton County and City of Fishers elderly population with a disability, whereas younger cohorts in need are reliant on more discretionary and/or participant-limited assistance programs. Page 7 of 46 4 Fishers Advisory Committee on Disability Housing Supply Analysis Accessible housing can take many forms and may include owner-occupied housing, group homes, and assisted living. It is estimated that there are approximately 3,300 licensed Supervised Group Living beds in Indiana available to eligible individuals with intellectual or developmental disabilities. These group homes typically range in size from 5-8 residences and the services provided on-site vary based on the age, needs, and interests of the residents. As of 2020, there are 29,078 owner-occupied housing units within the City of Fishers, although the accessibility status of each of these units is unknown. In the summer of 2022, a survey was completed by the City of Fishers Department of Planning and Zoning to determine the number of residential beds in assisted living and nursing homes facilities throughout Hamilton County. The housing inventory revealed that there were 542 adult independent units, 338 assisted living units, 204 memory care units, and 436 non-categorized units, totaling 1,520 units county wide. When asked to comment on the community’s greatest needs, multiple facilities included the lack of sufficient memory care beds. Nine of the 15 facilities surveyed accept only private pay residences, totally 1,080 units of the County’s total inventory. Five facilities, representing 372 units, do accept Medicare and/or Medicaid. Only one facility indicated that they provide services to younger residences. State of Aging In 2021, the City of Fishers commissioned Urban Partners to develop a housing study that would outline the current and future demand for housing within the City. A key take-away of this study was the future predicted demand for senior and elderly housing, involving supportive services and/or universally-designed features. This Image 3 Source: Table 44: Fishers Housing Demand by Tenure & Age of Householder (2020-2030) , Urban Partners, Fishers Housing Needs Analysis & Strategy 2022 Alt Text: Graph depicting future demand for housing within the City of Fishers, from 2020 through 2040, indcluding the projected need for 7,673 addtional households by 2040 for the 65+ age range, with a total of 13,115 addtional for all households. Page 8 of 46  Accessible Housing Guide 5 demand can be best summarized in the below chart: The 2021 Urban Partners Housing Study indicates that senior and elderly housing units will be the highest and most in-demand housing stock by 2040, outpacing the demand for 1st time homeowner and young adult renter housing units. Identified by Urban Partners in the subsequent Accessible Housing Study (2022) was the relative financial security of Fishers residents with disabilities that would prohibit them from living and/or working independently, and the future increasing in senior residents – which age segment is more likely to live with disability. Therefore, in light of this information, the City has developed this Accessible Housing Guide to organize the available Federal, State, and Local resources available to residents living with disability. Furthermore, resources are herein provided to real estate developers to anticipate the substantial future demand for senior and accessible housing within the area, as identified by the 2021 Urban Partners Housing Study. Image 4 Source: Table 2: Disability by Gender, Age, Race/Ethnicity, 2020, Urban Partners, Accessble Housing Report, 2023 Alt Text: Graph depiction of Gender, Age and Ethnicity breakdown of Hamilton County and City of Fishers dated 2020, including total population, people living with a disability, and % of the population living with a disability. Total City of Fishers Population 93,356, Total Population with a Disability 6,572, and % of the population is 7.03%, compared to Hamilton County’s 8.5% . Age 65-74, 16.4% of the population is living with a disability, Age 75+ 43.7% is living with a disability. Page 9 of 46 6 Fishers Advisory Committee on Disability REAL ESTATE DEVELOPMENT The following resources are provided to inform real estate developers of the assistance available to develop, redevelop, or rehabilitate housing for individuals with disabilities and their families. Assistance for development is offered at the State and Federal level, and may take the form of tax accreditation, grants, construction subsidies, and loan insurance. As identified by the analysis conducted by Urban Partners, new senior housing will be in high demand in the coming decades. The resources provided below are sought to encourage such necessary development. Real estate development may be driven by local private developers, nonprofit community development corporations, and large multinational organizations. Each of these entities are likely able to utilize most, if not all, of the various forms of assistance found described below. Indiana Supportive Housing Institute The Indiana Housing and Community Development Authority (IHCDA), in partnership with the Corporation for Supportive Housing (CSH), offers an annual Supportive Housing Institute to train teams consisting of developers, property managers, and supportive service providers on how to develop and operate supportive housing for persons experiencing homelessness. The Institute helps supportive housing partners learn how to navigate the complex process of developing housing with supportive services to prevent and end homelessness. The process is intended to reduce the time it takes to obtain funding for supportive housing by improving the planning and development process. Website: in.gov/developers/supportive-housing/ Image 5, 6, 7: IHCD, US. Department of Housing and Urban Development, Hamilton County, Indiana Alt Text: Indiana Housing & Community Development Authority Logo, U.S. HUD Logo, Hamilton County , Indiana Logo Page 10 of 46  Accessible Housing Guide 7 Low-Income Housing Tax Credits Low Income Housing Tax Credits are the largest source of Federal funding aviliable for new construction of affordable rental housing. This program is not a grant or a loan, but rather a dollar-for-dollar credit applied to the amount of taxes needed to be paid on the development. Both multi-family and single- family developments are elgible for this credit. Website: huduser.gov/portal/datasets/lihtc Assited Living Conversion Program The Assited Living Conversion Program is federally administered grant through the U.S. Department of Housing and Urban Development that provides funding to convert all or some units within an existing residential development into Assisted Living or Service Enriched facilites. Only private nonprofits entitites are eligible to recieve these funds. Website: hud.gov/program_offices/housing/mfh/progdesc/alcp Section 811 Supportive Housing Section 811 offers federally-administered loans, through HUD, that assist nonprofit entities in the development (i.e. new construction) of low and extremely-low income Assisted Living/Supportive rental facilities. Website: hud.gov/program_offices/housing/mfh/progdesc/disab811 Senior Housing Mortgage Insurance This federally-administered program through HUD offers insurance protection for FHA and other qualified loans for the development or rehabilitation of elderly/ senior rental housing. Public, private, nonprofit, and institutional organizations may apply for and make use of such aid. Website: hud.gov/programs_offices/housing/mfh/progdesc/progsec231 Page 11 of 46 8 Fishers Advisory Committee on Disability HOME Program This federally-administered program through HUD offers insurance protection for FHA and other qualified loans for the development or rehabilitation of elderly/senior rental housing. Public, private, nonprofit, and institutional organizations may apply for and make use of such aid. Website: hud.gov/program_offices/comm_planning/home Community Development Block Grant (CDBG) Commuinty Development Block Grant, known as CDBG, are federally-administered grants through HUD that provide grant funding for development projects. These grants are the largest source of Federal funds available for redevelopment and rehabilitation, and may be sought by any public or private entity through the Hamilton County CDBG Program Manager. Website: hamiltoncounty.in.gov/1364/Community-Development-Block-Grants Image 8: South Point Village Apartments Courtesy of RealAmerica LLC. Alt Text: A four-story grey brick multi-family apartment building with a community gardens Page 12 of 46  Accessible Housing Guide 9 HOME IMPROVEMENTS Improvements to the residences of persons with disabilities include the construction of Universal Design features such as ADA ramps, widened doorways, sound proofing, light proofing, and more. These projects may be funded via a number of State and Federal programs that seek to provide residents with the funds necessary for such home improvements. While individuals with intellectual and developmental disabilities (IDDs) do not necessarily have physical mobility issues, some may prefer access units with physical modifications given the frequent overlap between IDD and physical disabilities. Residents with physical disabilities may refer to the Fishers Universal Design Brochure, attached in the appendix, or downloaded here, in order to consider making improvements to their home that may result in an improved livelihood, longevity, and ease of access. A 2020 report titled “A Place in the World” also provides universal language for neuro-inclusive housing to help guide people to better understand housing preferences, accessibility needs, and supportive services. The report can be downloaded at Image 9 Alt Text: An image of the two-page document entitled firstplaceaz.org. Fishers Universal Design Brochure Image 10 Source: Home Safe Home, homesafehomemd.com Image 11 Source: Kohler, probuilder.com/accessibility Alt Text: A metal ramp home leading to a front door in front of a blue house Alt Text: An image of a bathroom with an accessible tub and floating sinks Page 13 of 46 10 Fishers Advisory Committee on Disability Federal Title 1 Loans Title 1 Property Improvement Loans are federally-backed personal loans that support repairs to owner-occupied residences. These funds may not be used to construct a new residential structure, but rather to make repairs to, or bring up to code, existing residential structures. Website: prosthetics.va.gov/psas/HISA2.asp Home Improvement & Structural Alteration Program The HISA program, through the Department of Veteran Affairs (VA), provides funds to construct necessary accessibility improvements and home repairs for veterans and active service-members. New residential construction is not applicable. Website: hud.gov/program_offices/housing/sfh/title/ti_abou Rebuilding Together Rebuilding Together is a nonprofit and volunteer organization dedicated to providing home improvements to seniors, veterans, and those with disability. Their work is completed at no charge to the home-owner. Eligible homes must be owned and occupied by the applicant. Website: rebuildingtogetherindy.org/what-we-do Ramp-Up Indiana Ramp-Up Indiana provides grants to nonprofit organizations for the installation of exterior ramps to homes occupied by those needing improve the accessibility of their homes. While not explicitly available to home-owners, home-owners may contact local non-profits to determine the availability of such funds. Website: in.gov/ihcda/program-partners/ramp-up-indiana/ Page 14 of 46  Accessible Housing Guide 11 HOUSING ASSISTANCE Individuals and their families may seek assistance for housing meant to cater to their specific financial, physical, or developmental needs. Such aid may be sought from State and Federal entities, and in a manner similar to the previously discussed resources, may take the form of waivers, vouchers, and emergency assistance. Support may be sought to locate and procure housing, subsidize housing, and relieve residents of impending eviction or foreclosure. Please note that vouchers are distributed by the US and Indiana Departments of Housing and Urban Development (HUD), and therefore are not always offered in each region/municipality, depending on the allocations provided each year. More information regarding Fishers income demographics and housing statistics can be found in the Urban Partners studies. Housing Assistance programs includes Hamilton County Trustees, Indiana Homeowners Assistance, Housing Choice Voucher, Non-Elderly Disabled Vouchers, Designated Housing Voucher, Certain Developments Voucher, Project Access Pilot Program, and Permanent Supportive Housing. Image 12 Source: 877gethope.org/ihaf-servicers Alt Text: Steps to Complete for IHAF. Before you participate in IHAF and start communicating with borrowers, there are a few actions you must first take. Not completing these tasks will prevent funds from reaching you quickly. 1. Review servicer website, FAQ, presentation, and terms. 2. Review and sign the IHAF Servicer Agreement. 3. Receive FAMS portal access and complete registration. 4. Gather borrowers who are 90+ days delinquent and start planning outreach to encourage participation. 5. Send outreach letter to delinquent borrowers (info on how to apply to the IHAF program). Page 15 of 46 12 Fishers Advisory Committee on Disability Hamilton County Trustees The Hamilton County Trustees Association provides emergency rental and utility assistance for qualifying residents, as awarded by the Federal government. Website: hctaindiana.com/?locale=en Indiana Homeowner Assistance Fund (IHAF) This fund is administered by the Indiana Foreclosure Prevention Network and seeks to provide residents experiencing unusual and immediate hardships, and those with incomes below the area median, with mortgage payment assistance for up to 6 months and not exceeding a total value of $35,000. The graphic shown on the previous page shows steps on how to complete IHAF. Website: 877gethope.org Housing Choice Voucher Community Action of Greater Indiana administers the Section 8 Housing Voucher in Hamilton County. This voucher secures subsidized housing from willing landlords. Website: in.gov/ihcda/ Permanent Supportive Housing Administered by the IHCDA, this State-funded program assists individuals and families with disabilities experiencing homelessness with the goal of securing long-term stable housing and self-sufficiency. Website: in.gov/ihcda/ Image 13 Source: Indy Star, indystar.com Image 14 Source: Woda Cooper Companies, wodagroup.com Alt Text: Outdoor amenties at Proctor Place, Indianapolis, IIN Alt Text: Community Room at Proctor Place, Indianapolis, IN Page 16 of 46  Accessible Housing Guide 13 Non-Elderly Disabled Vouches (NED) The US Deptment of Housing and Urban Development (HUD) offers various vouchers for non-elderly residents with disability to procure, finance, or lease housing. There is a limit to the number of vouchers offered per year. Designated Housing Voucher: > Enables families with disabilities the ability to move to another publicly subsidized rental unit in another housing development > Enables families with disabilities to rent a unit in an area wherein they were precluded by elderly-only rentals Certain Development Voucher: > Enables non-elderly families who do not currently receive housing assistance to receive rental assistance in housing developments that restrict occupancy to elderly families Project Access Piliot Program: > Provides non-elderly persons with disability transitioning from nursing homes, or other institutions, into a private residence with a rental housing voucher. Website: hud.gov Image 15: Woda Cooper Companies, wodagroup.com Alt Text: Aerial image of the 61-unit Proctor Place Housing development located in Indianapolis, Indiana, which inlcudes 15 permanent supportive housing units for homeless or at-risk veterans. Page 17 of 46 14 Fishers Advisory Committee on Disability MEDICAL & PERSONAL AID Individuals and their families may seek assistance for medical and personal care in the form of waivers and subsidized services. Assistance is offered through various State and Federal entities, such as Medicaid and the Division of Aging and Rehabilitative Services. Various services, offered pro-bono or for purchase, are available through several local and regional non-profit organizations. The below resources are not an exhaustive list of the assistance available, but rather a survey of the most widely available programs for current or future Fishers residents. Further resources are available through the various organizations and entities listed below, depending on the assistance or aid required. State Waivers The HISA program, through the Department of Veteran Affairs (VA), provides funds to construct necessary accessibility improvements and home repairs for veterans and active service-members. New residential construction is not applicable. Medical Model Waivers: > Aged & Disabled Waiver > Traumatic Brain Injury Waiver CHOICE Program: > Case Management > Respite Care > Home-Delivered Meals > Attendant Care > Homemaker Services > Medical Supplies > Day Programs Web Websites: cicoa.org and in.gov/fssa Page 18 of 46  Accessible Housing Guide 15 Non-Profit Services The below provides a brief overview of the various non-profit services that are available to Fishers residents. Such services may include support for residents with developmental disabilities through therapy, employment, occupational, guardianship, and coordination services. Opportunities for Positive Growth AccessABILITY > Occupational Therapy > Advocacy Services > Employment Services > Violence and Assault Support Shepherd’s Center of Hamilton County > Independent Living Support > Outreach Services > Transition Services > Legal Advocacy > Mentorship Services Janus Developmental Services: Advocates Personal Care > Work Experience Program > Daily Living Support > Entrepreneurship Program > Personal Care Services > Transportation Services Indiana Disability Justice Outside the Box > Maintains an online resource hub that provides the contact > Recreational Services information for various service providers > Educational Services > Employment Services Page 19 of 46 16 Fishers Advisory Committee on Disability CONTACT INFORMATION Federal Resources US Dept. of Housing and Urban Development 202-708-1112 www.hud.gov State Resoruces Indiana Family & Social Security Administration (800) 457-8283 www.in.gov/fssa/ Indiana Medicaid (800) 457-4584 www.in.gov/medicaid/members/member-resources/contact-us/ Indiana Department of Housing and Urban Development (800) 225-5342 www.hud.gov/states/indiana/offices Indiana Housing & Community Development Authority (800) 872-0371 www.in.gov/ihcda/ Indiana Disability Justice INdisabilityjustice@gmail.com www.indisabilityjustice.org/ Indiana Office of Community and Rural Affairs (OCRA) (317) 233-3762 www.in.gov/ocra/cdbg/ Page 20 of 46  Accessible Housing Guide 17 THE FISHERS ADVISORY COMMITTEE ON DISABILITY Image 16: Fishers Advisory Commitee on Disability, 2022 Alt Text: The Fishers Advisory Committee on Disability from Left to Right. Back Row: Ross Hilleary, ADA Coordinator, Chrissy Pogue, Shelby Slowik, Co-Chair Cecilia Coble, Co-Chair Kelly Hartman, and Stacey Oldham Front Row: Darcy Keith, Michelle Steltz, and Wilbur Sutton Alt Text Image 17: Fishers Advisory Committee on Disability Logo Page 21 of 46  www.fishers.in.us Alt Text Image 18: City of Fishers, Indiana Logo Page 22 of 46  APPENDIX: A ACCESSIBLE HOUSING STUDY Prepared by Urban Partners March 1, 2023 Alt Text Image 19: Fishers Advisory Committee on Disability Logo Page 23 of 46 ACCESSIBLE HOUSING REPORT City of Fishers, IN Draft 4.1 Prepared by: URBAN PARTNERS March 1, 2023 Page 24 of 46 Study Background Urban Partners was asked by the City of Fishers to assess the availability of accessible housing to serve the needs of individuals with disabilities. For the purposes of this review, accessible housing included not only residential units designed to accommodate individuals with physical disabilities but also housing at which supportive services that allow for individuals with intellectual, developmental, and mental health difficulties to live independently within the community. Demand Analysis The American Community Survey (ACS), which is published by the U.S. Census Bureau every year, collects a snapshot of detailed data from a sampling of households and extrapolates this data to estimate broader community characteristics. The ACS identifies the following six categories of disabilities and identifies both the total number of individuals who report having a disability, as well as the number of people who report specific disability status: • Hearing: deaf or had serious difficulty hearing. • Vision: blind or had serious difficulty seeing even when wearing glasses. • Cognitive: serious difficulty concentrating, remembering, or making decisions. • Ambulatory: having serious difficulty walking or climbing stairs. • Self-Care: difficulty dressing or bathing. • Independent Living: have difficulty doing errands alone such as visiting a doctor’s office or shopping due to a physical, mental, or emotional condition. As shown in Table 1, approximately 8.4%, or 27,783 Hamilton County residents reported a disability of some type in 2020. As a component of this number, approximately 7.0% of City of Fishers residents, representing 6,572 of the City’s 2020 population of 93,356, reported having a disability. Table 1: Disability Status, 2020 Total Civilian Civilian Population % Civilian Population Population with a Disability with a Disability Hamilton County 328,983 27,783 8.4% City of Fishers 93,356 6,572 7.0% Source: U.S. Census Bureau, Urban Partners As shown in Table 2 on the following page, Fishers’ population with disabilities closely parallels the County’s by gender, age, and race/ethnicity. Older populations at both the County and City level report the highest prevalence of disability. Fishers Accessible Housing Report (Draft 4.1) 2 Page 25 of 46 Table 2: Disability by Gender, Age, Race/Ethnicity, 2020 Hamilton County City of Fishers Total With a % with a Total With a % with a Civilian Disability Disability Civilian Disability Disability Population Population Sex Male 160,699 13,283 8.3% 45,123 3,184 7.1% Female 168,284 14,500 8.6% 48,233 3,388 7.0% Age Under 5 years 21,451 98 0.5% 6,209 0 0.0% 5 to 17 years 67,532 2,987 4.4% 20,121 998 5.0% 18 to 34 years 64,397 3,869 6.0% 18,644 896 4.8% 35 to 64 years 135,631 9,478 7.0% 39,484 2,347 5.9% 65 to 74 years 24,706 4,554 18.4% 5,692 931 16.4% 75 years and over 15,266 6,797 44.5% 3,206 1,400 43.7% Race/Ethnicity White Alone 283,009 25,124 8.9% 77,675 6,048 7.8% Black or African American Alone 12,718 859 6.8% 5,415 337 6.2% American Indian/Alaska Native Alone 498 33 6.6% - - - Asian Alone 20,008 892 4.5% 6,684 28 0.4% Native Hawaiian/Other Pacific Islander Alone 102 0 0.0% 26 0 0.0% Some Other Race Alone 2,645 98 3.7% 1,105 0 0.0% Two or More Races 10,003 777 7.8% 2,451 159 6.5% White Alone, Not Hispanic or Latino 273,254 24,516 9.0% 75,469 5,941 7.9% Hispanic or Latino (Of Any Race) 13,545 1,082 8.0% 3,223 153 4.7% Source: U.S. Census Bureau, Urban Partners Table 3 details disabilities reported by type and by age distribution for Hamilton County and the City of Fishers. In the City of Fishers, 2.9% of residents report cognitive difficulties, 2.5% ambulatory difficulties, 2.2% hearing difficulties and 0.9% vision difficulties. The census data also tracks the number of people who report multiple disabilities. Table 3: Disability Characteristics by Age Groups, 2019 Hamilton County City of Fishers Total With a % with a Total With a % with a Civilian Disability Disability Civilian Disability Disability Population Population Hearing Difficulty 8,516 2.6% 2,092 2.2% Population Under 5 Years 21,451 26 0.1% 6,209 0 0.0% Population 5 to 17 Years 67,532 309 0.5% 20,121 132 0.7% Population 18 to 34 Years 64,397 435 0.7% 18,644 131 0.7% Population 35 to 64 Years 135,631 3,005 2.2% 39,484 896 2.3% Population 65 to 74 Years 24,706 1,684 6.8% 5,692 286 5.0% Population 75 Years and Over 15,266 3,057 20.0% 3,206 647 20.2% Fishers Accessible Housing Report (Draft 4.1) 3 Page 26 of 46  Hamilton County City of Fishers Total With a % with a Total With a % with a Civilian Disability Disability Civilian Disability Disability Population Population Vision Difficulty 4,355 1.3% 852 0.9% Population Under 5 Years 21,451 72 0.3% 6,209 0 0.0% Population 5 to 17 Years 67,532 272 0.4% 20,121 13 0.1% Population 18 to 34 Years 64,397 734 1.1% 18,644 154 0.8% Population 35 to 64 Years 135,631 1,510 1.1% 39,484 383 1.0% Population 65 to 74 Years 24,706 648 2.6% 5,692 88 1.5% Population 75 Years and Over 15,266 1,119 7.3% 3,206 214 6.7% Cognitive Difficulty 10,041 3.3% 2,519 2.9% Population Under 18 Years 67,532 2,331 3.5% 20,121 788 3.9% Population 18 to 34 Years 64,397 2,672 4.1% 18,644 587 3.1% Population 35 to 64 Years 135,631 2,864 2.1% 39,484 611 1.5% Population 65 to 74 Years 24,706 667 2.7% 5,692 146 2.6% Population 75 Years and Over 15,266 1,507 9.9% 3,206 387 12.1% Ambulatory Difficulty 10,676 3.5% 2,177 2.5% Population Under 18 Years 67,532 190 0.3% 20,121 48 0.2% Population 18 to 34 Years 64,397 278 0.4% 18,644 11 0.1% Population 35 to 64 Years 135,631 3,820 2.8% 39,484 838 2.1% Population 65 to 74 Years 24,706 2,530 10.2% 5,692 522 9.2% Population 75 Years and Over 15,266 3,858 25.3% 3,206 758 23.6% Source: U.S. Census Bureau, Urban Partners As summarized in Table 4 shown on the following page, the prevalence of multiple disabilities increases with age at both the County and City levels. Approximately 22% of the County’s population of children with disabilities report having more than one type of disability (13.6% in the City of Fishers)—compared to 33.7% of the County’s adult population under 65 with disabilities (22.1% in the City of Fishers) and 45.8% of its elderly population with disabilities (52.1% in the City of Fishers). It should be noted that this census data does not provide information about the severity of an individual’s disabilities or guidance about whether accessible housing and/or residential supports are necessary to accommodate those disabilities. Thus, this census data regarding the characteristics of specific disabilities and the prevalence of multiple disabilities is not particularly useful in estimating the number of individuals who might require accessible housing and/or other residential supports or, indeed, what those residential accommodations or supports should be. Fishers Accessible Housing Report (Draft 4.1) 4 Page 27 of 46 Table 4: Age by Number of Disabilities, 2019 Hamilton % City of % County Fishers Total: 328,983 93,356 Under 18 years: 88,983 26,330 - With one type of disability 2,414 862 - With two or more types of disability 671 21.8% 136 13.6% - No disability 85,898 25,332 18 to 64 years: 200,028 58,128 - With one type of disability 8,850 2,527 - With two or more types of disability 4,497 33.7% 716 22.1% - No disability 186,681 54,885 65 years and over: 39,972 8,898 - With one type of disability 6,151 1,116 - With two or more types of disability 5,200 45.8% 1,215 52.1% - No disability 28,621 6,567 Source: U.S. Census Bureau, Urban Partners Program for All-Inclusive Care to the Elderly (PACE) In 2016, Myers & Stauffer, an accounting firm specializing in governmental health policy, was retained by the Indiana Family and Social Services Administration (FSSA) to complete a Geographic Market Analysis for Indiana’s Program for All- Inclusive Care to the Elderly (PACE) program. The purpose of this study was to estimate the state’s population with a disability, specifically those income-qualified individuals with disabilities over the age of 55 who would be clinically eligible to receive nursing home care but who might continue to live safely within the community if provided PACE-funded health and home care, transportation services, prescription coverage, etc. Rather than focus on the potential housing and care needs posed by specific disabilities, Myers & Stauffer’s For download the full Geographic Market methodology proposed using the Self Care and Analysis report, click this link. Independent Living criteria as low and high estimates of the population in need. (Indiana Pace Study Geographic Market Analysis, p. 3). Question 18C of the ACS, relating to self-care, asks respondents if they have difficulty dressing or bathing. Since difficulty with these activities are two of the specific Activities of Fishers Accessible Housing Report (Draft 4.1) 5 Page 28 of 46 Daily Living (ADLs) used by health care providers to assess an individual’s self-care needs, Myers & Stauffer reasoned that this indicator could be used to calculate a low estimate of the number of Indianians who would meet the critical eligibility criteria of the PACE program. Question 19 of the ACS identifies the number of people who have difficulty doing errands alone—such as visiting a doctor’s office or shopping—due to a physical, mental or emotional condition, which are considered Independent Living difficulties. Health care providers consider these activities to be Instrumental Activities of Daily Living (IADLs) in making care recommendations. Myers & Stauffer reasoned that this indicator could be used to calculate a high estimate of the number of Indiana residents who would meet the critical eligibility criteria of the PACE program. While the PACE program is available only to older Indiana residents, this approach seems a reasonable one to use in estimating the number of Fishers residents who potentially require accessible housing and/or residential supports due to developmental, intellectual, mental health or physical disability/disabilities. Additionally, this ACS data can be revisited in future years to allow the City of Fishers to identify any substantial changes in the size or characteristics of this population and revise its efforts to promote the provision of accessible housing accordingly. Table 5, shown on the following page, details the incidence of self-care and independent living difficulties in the Hamilton County and City of Fishers population. As shown on this table, 955 City of Fishers residents under the age of 18, or 1.1% of this population, report limitations in their ADLs that may require the provision of accessible housing, compared to a rate of approximately 1.3% for Hamilton County as a whole. Older residents account for the greatest share of those with ADL limitations—with 14.9% of Fishers’ residents over the age of 75 reporting ADL limitations compared to 10.7% countywide. Interestingly, Fishers residents over 75 comprise only 3.7% of the City’s population over the age of 5, compared to County residents over 75 accounting for 5.0% of the County’s population over the age of 5. The table also shows that approximately 1,857 City of Fishers residents over the age of 18 (IADLs are identified only for the adult population), or 2.8% of its adult population, report limitations in their ADLs that may require the provision of accessible housing, compared to a rate of 3.4% for Hamilton County as a whole. Older residents account for the greatest share of those with ADL limitations—with 26.3% of Fishers’ residents over the age of 75 reporting ADL limitations compared to 22.2% countywide. Fishers’ somewhat higher share of older adults with ADL and IADL limitations may be due in part to the fact that many of the County’s assisted living and memory care beds are located within the City of Fishers—this data point may be skewed by the fact that residents originally from elsewhere in Hamilton County are now residing in accessible residential facilities that were developed within the City of Fishers. Fishers Accessible Housing Report (Draft 4.1) 6 Page 29 of 46 Table 5: Population with Self-Care and Independent Living Difficulties, 2019 Hamilton County City of Fishers Total With a % with a Total With a % with a Civilian Disability Disability Civilian Disability Disability Population Population Self-Care Difficulty 3,970 1.3% 955 1.1% Population Under 18 Years 67,532 455 0.7% 20,121 103 0.5% Population 18 to 34 Years 64,397 299 0.5% 18,644 40 0.2% Population 35 to 64 Years 135,631 1,221 0.9% 39,484 250 0.6% Population 65 to 74 Years 24,706 358 1.4% 5,692 85 1.5% Population 75 Years and Over 15,266 1,637 10.7% 3,206 477 14.9% Independent Difficulty1 8,064 3.4% 1,857 2.8% Population 18 to 34 Years 64,397 1,246 1.9% 18,644 169 0.9% Population 35 to 64 Years 135,631 2,563 1.9% 39,484 566 1.4% Population 65 to 74 Years 24,706 871 3.5% 5,692 280 4.9% Population 75 Years and Over 15,266 3,384 22.2% 3,206 842 26.3% Mean Estimate All Ages 6,245 1,458 Population Under 18 Years 455 103 Population 18 to 64 Years 2,665 513 Population 18 to 34 Years 773 105 Population 35 to 64 Years 1,892 408 Population 65 Years and Over 3,125 842 Population 65 to 74 Years 615 183 Population 75 Years and Over 2,511 660 Source: U.S. Census Bureau, Myers & Stauffer, Urban Partners The Myers & Stauffer study averaged the low (ADL) and high (IADL) estimates to develop a mean estimate of the number of Indiana residents whose physical, intellectual, developmental or mental health condition may require accessible housing and/or daily residential supports. Table 5 also shows this mean for Hamilton County and City of Fishers accessible housing and/or residential support demand. While the ACS data is an estimate based on the extrapolation of information provided by a limited number of surveyed households and should not be considered precise, this mean estimate seems an appropriate order of magnitude snapshot of the number of disabled residents in Hamilton County and within the City of Fishers who are potentially in need of accessible housing and/or supportive services. As of 2020, it is estimated that there are approximately 1,458 Fishers residents with activity limitations significant enough to merit residential accommodations and/or supportive services, including 103 children, 513 adults under the age of 65 and 842 above the age of 65. Because IADLs are not assessed for children (who would not be expected to live 1 Independent living difficulties not attributed to minors. Fishers Accessible Housing Report (Draft 4.1) 7 Page 30 of 46 independently regardless of disability), the estimate of need for the 0-18 age cohort is based on ADLs alone. Determining the ability of disabled residents and their families to pay for necessary residential accommodations and supportive services is also difficult. One of the characteristics the ACS uses in reporting the incidence of poverty is an individual’s disability status. At the County level, information is available in incremental levels about the general population—less than 50% poverty level, 100% poverty level, and 125% poverty level. As shown in Table 6, Hamilton County residents with disabilities are more likely to have been living in poverty during the last 12 months than the overall population. In 2020, 3.5% of the disabled community was living at less than 50% of the determined poverty level, compared to 2.2% of the general population. Similarly, 9.6% of the population with a disability was reported to be living at the 100% poverty level, compared to 3.9% of the general public—and 12.0% of the population with a disability was living at the 125% poverty level, compared to 5.4% of the population overall. Table 6: Poverty Level by Disability Status, Hamilton County, 2019 Total < 50% < 100% < 125% Population Poverty Poverty Poverty Population for Whom Poverty Status is Determined 328,349 2.3% 4.4% 5.9% Disability Status With Any Disability 27,681 3.5% 9.6% 12.0% No Disability 300,524 2.2% 3.9% 5.4% Source: U.S. Census Bureau, Urban Partners At the City level, census data is available that detail those living above and below the 100% poverty level by age and by disability. Although this information does not provide the income gradations that can be useful in considering eligibility for some public supports, it is helping in identifying the largest population of financially vulnerable disabled residents. As shown in Table 7 on the following page, children and adults aged 18-64 with a disability experience the greatest level of poverty, with the poverty rate of the elderly population with a disability appreciably lower. The availability of state and federal benefits geared towards seniors, regardless of disability status, likely contributes to the lesser incidence of poverty among Hamilton County and City of Fishers elderly population with a disability, whereas younger cohorts in need are reliant on more discretionary and/or participant-limited assistance programs. According to the census, 16.4% of the County’s children with a disability live below the poverty line (9.9% in the City of Fishers), as do 12.0% of the County’s adults aged 18-64 with a disability (8.0% in the City of Fishers) and 5.1% of the County’s elderly population with a disability (1.7% in the City of Fishers). Table 7 also identifies the population of individuals living in poverty who do not have a disability. For both the child and adults aged 18-64 age cohorts, the prevalence of poverty among the population without a disability is three to four Fishers Accessible Housing Report (Draft 4.1) 8 Page 31 of 46 times lower than within the disabled community at the Hamilton County level and within the City of Fishers (although the number of people impacted by poverty is greater, due to the larger size of the population without a disability). Interestingly, the City of Fishers’ elderly population with a disability experiences poverty at a rate lower than the population without a disability, reporting a 1.7% poverty rate compared to a poverty rate of 2.3% for the City’s population without a disability over the age of 65. Table 7: Age by Disability Status by Poverty Status Hamilton County City of Fishers Total Civilian Total Civilian Population % Population % Under 18 Years: 88,265 26,166 With a disability: 2,983 998 Income in the past 12-months below poverty level 489 16.4% 99 9.9% Income in the past 12-months at or above poverty level 2,494 899 No disability: 85,282 25,168 Income in the past 12-months below poverty level 4,154 4.9% 616 2.4% Income in the past 12-months at or above poverty level 81,128 24,552 18 to 64 Years: 199,968 58,128 With a disability: 13,347 3,243 Income in the past 12-months below poverty level 1,604 12.0% 260 8.0% Income in the past 12-months at or above poverty level 11,743 2,983 No disability: 186,621 54,885 Income in the past 12-months below poverty level 6,681 3.6% 1,561 2.8% Income in the past 12-months at or above poverty level 179,940 53,324 65 Years and Over: 39,972 8,898 With a disability: 11,351 2,331 Income in the past 12-months below poverty level 575 5.1% 39 1.7% Income in the past 12-months at or above poverty level 10,776 2,292 No disability: 28,621 6,567 Income in the past 12-months below poverty level 903 3.2% 152 2.3% Income in the past 12-months at or above poverty level 27,718 6,415 Source: U.S. Census Bureau, Urban Partners Unfortunately, as with other census data regarding disabilities, this dataset does not identify whether those individuals with disabilities living below or near the poverty level have disabilities severe enough to require accessible housing and/or the provision of supportive services. In the 2016 Myers & Stauffer study, PACE program financial eligibility was estimated by calculating the percentage of individuals living in poverty in a given area, multiplying this number by a factor of 2.2 to adjust for the PACE eligibility criteria that is actually higher than the poverty level, and then multiplying this rate to the number of people living in that community with self-care (ADL) difficulties and independent-care (IADL) difficulties. The Fishers Accessible Housing Report (Draft 4.1) 9 Page 32 of 46 mean of these low and high estimates was determined to be an appropriate estimate of the population that met both the clinical and financial eligibility requirements of the PACE program. Because PACE program participation is limited to those 65 and older, the Myers & Stauffer analysis considered only this cohort. While we understand that younger individuals with ADL and IADL difficulties are not eligible for PACE support, as in determining clinical eligibility, we have also applied this methodology to the younger population with a disability in order to estimate the number of income-vulnerable individuals with disabilities within Hamilton County and the City of Fishers who, due to their activity limitations, would be most likely to require accessible housing and/or the provision of supportive services that allow them to continue to function in their existing residence but would be least equipped to pay for such housing and supportive services. Table 8 identifies the poverty rate by age cohort for Hamilton County and the City of Fishers’ population overall, applies the 2.2 multiplier that Myers & Stauffer and FSSA agreed most closely aligns with the program’s financial eligibility requirements, and then calculates the number of Hamilton County and City of Fishers residents in all age cohorts that, having met PACE program’s clinical eligibility standards (shown in Table 5), would also be available for PACE program funding if it was available regardless of age. As with our determination of clinical eligibility, the number of children with disabilities whose families are of an income that would hypothetically qualify them for PACE participation is based only on the low ADL estimate. This analysis estimates that approximately 548 County residents, including 53 children, 240 adults under 65 and 254 older adults have activity and independence limitations significant enough and incomes low enough that that would qualify for the PACE program should that program be available for their age cohort. Within Fishers, this estimate is 80— including 6 children, 35 adults under the age of 65 and 39 older adults have activity and independence limitations significant enough and incomes low enough that they would qualify for the PACE program should that program be available for their age cohort. Table 8: Estimate of PACE Clinical and Financial Eligibility Hamilton County City of Fishers Total With a % with a Total With a % with a Population Population Disability Disability Disability Disability Poverty Rate Poverty Rate (with 2.2x (with 2.2x multiplier)) multiplier)) With a Self-Care Difficulty 3,970 955 1.1% Population Under 18 Years 11.7% 455 53 5.9% 103 6 Population 18 to 64 Years 9.0% 1,520 137 6.8% 290 20 Population 65 Years and Over 8.1% 1,995 162 4.6% 562 26 With a Independent Difficulty 8,064 1,857 Population 18 to 64 Years 9.0% 3,809 344 6.8% 735 50 Population 65 Years and Over 8.1% 4,255 346 4.6% 1,122 52 Fishers Accessible Housing Report (Draft 4.1) 10 Page 33 of 46  Hamilton County City of Fishers Total With a % with a Total With a % with a Population Population Disability Disability Disability Disability Poverty Rate Poverty Rate (with 2.2x (with 2.2x multiplier)) multiplier)) Mean Estimate All Ages 548 80 Population Under 18 Years 455 53 103 6 Population 18 to 64 Years 2,665 240 842 35 Population 65 Years and Over 3,125 254 842 39 Source: U.S. Census Bureau, PACE, Urban Partners Fishers Accessible Housing Report (Draft 4.1) 11 Page 34 of 46 Supply Analysis There is very little supply of accessible public housing available for individuals with disabilities and most of the private supply cannot be easily quantified. For example, a family with a member having a physical disability may retrofit their home to provide one-floor living, adequately wide doorways and hallways, accessible bathrooms, a modified kitchen, etc., yet this home will not appear on any inventory of accessible houses. Similarly, due to Fair Housing Act requirements, realtors and landlords are prohibited from reporting the disability status of renters and buyers. What we do know about the supply of accessible and supportive housing—and its ability to meet the demands of the Hamilton County and City of Fishers community—comes from information about assisted living and nursing home facilities, group home facilities, developments that have been financed using programs that require/encourage a set-aside for community-based housing for those with disabilities and from non-profit organizations that serve populations with disabilities. Because the supply of accessible housing is limited, there is likely significant fluidity within the region, with a disabled individual from Fishers in need of appropriate housing moving to another community if a unit becomes available there, and vice versa. Assisted Living/Nursing Home Facilities In the summer of 2022, a survey was completed by the City of Fishers Department of Planning and Zoning to determine the number of residential beds in assisted living and nursing home facilities throughout Hamilton County. Table 9 shown on the following page details these preliminary findings (four have not yet responded). This housing inventory includes 542 adult independent units (some housing multiple residents), 338 assisted living units, 204 memory care units, and 436 non-categorized units, totaling 1,520 units countywide. (An additional 119 adult independent units are planned by the Clover Communities to be developed in Fishers.) The 1,005 units that are not categorized as independent living provide accommodations for only approximately one-third of the 3,125 Hamilton County residents over the age of 65 identified in Table 5 as having significant enough ADL or IADL limitations to warrant accessible housing and/or supportive services. While there was at least 5% vacancy in each unit type overall, many of the facilities providing memory care beds reported no vacancies and the existence of wait lists. Indeed, when asked to comment on the community’s greatest needs, multiple facilities indicated the lack of sufficient memory care beds. These residential facilities were also asked about the types of payments that they accept. Nine of the 15 facilities surveyed to date accept only private-pay residents, representing 1,080 units of the County’s total inventory. Five facilities, representing 372 units, do accept residents eligible for Medicare and/or Medicaid, but not all beds at these facilities are necessarily currently occupied by Medicare or Medicaid recipients. Only one facility indicated that they provide services to younger residents—in this case, to one individual having significant developmental disabilities. Fishers Accessible Housing Report (Draft 4.1) 12 Page 35 of 46 Table 9: Survey of Residential Care Providers Source: City of Fishers, Urban Partners Fishers Accessible Housing Report (Draft 4.1) 13 Page 36 of 46 PACE-Supported Services Ironically, although we have used PACE program eligibility requirements to estimate the number of Hamilton County and City of Fishers residents with significant enough disabilities to require accessible housing and/or residential supports and the subset of these who hypothetically qualify for financial assistance in accessing these services, the PACE program itself does not currently serve the Hamilton County area. Myers & Stauffer determined, in a 2016 companion piece titled “Proposed PACE Regions Report” that a new Indianapolis Northeast PACE Region was feasible based on the quantity and density of need and the availability of potential sponsoring health care organizations and nursing home/rehabilitation centers. This area included 23 zip codes not currently included in another PACE service area, including five of Fishers six zip codes (excluding 46085). Interestingly, all of the named potential sponsoring organizations are located in Marion County, despite including portions of both Boone and Hamilton County. (Indiana PACE Study Proposed PACE Regions, pp. 17-19). State-Administered Assistance Information provided by the Indiana Family and Social Services Administration’s (FSSA) Bureau of Developmental Disabilities Services (BDDS), accurate as of January 2023, offers some context about the ability of various housing and Medicare Waiver programs to meet the needs of Indiana residents requiring accessible housing and supportive programs. Unfortunately, most of this information is provided at the statewide level with only limited information pertaining to the supply and demand for services made available at the district level—the eight geographic areas BDDS uses to administer services throughout the state. Fishers is located in the large and socio-economically diverse District 5, which includes Boone, Hamilton, Hancock, Hendricks, Johnson, Marion, Morgan, and Shelby To download the full Introduction to Indiana’s Counties and, which, as of the 2020 Census, housed Medicaid Waiver Program, click this link. 28.4% of Indiana’s total population. It is impossible to determine, from either the statewide or District 5 data, the availability of services within Fishers or the ability of these programs to meet the needs of Fishers’ residents within the proximate area. However, this data is useful providing a snapshot of the supply and demand characteristics for various supports which are experienced in Indiana in the greater Indianapolis region represented by District 5 and Indiana as a whole. Fishers Accessible Housing Report (Draft 4.1) 14 Page 37 of 46 Group Homes – Statewide2 As shown on Table 10, BDDS reports a statewide inventory of 2,960 licensed Supervised Group Living beds in Indiana available to eligible individuals with intellectual or developmental disabilities. These group homes typically range in size from 5-8 residents and the services provided on-site vary based on the age, needs and interests of the residents. Eligibility requirements include an intellectual or developmental disability with an onset prior to the age of 22 and income qualification for a compatible Medicaid program benefit. Table 10: Shared Group Home Availability District District District District District District District District Total 1 2 3 4 5 6 7 8 Shared Group Living 207 554 331 361 564 391 261 291 2,960 Capacity Shared Group Living 20 54 29 52 60 48 21 33 317 Vacancy Currently Served 187 500 302 309 504 343 240 258 2,643 Vacancy Rate 9.7% 9.7% 8.8% 14.4% 10.6% 12.3% 8.0% 11.3% 10.7% Source: Indiana Family and Social Services Administration, Urban Partners As of January 2023, 564 of these beds were located within the District 5 area, representing 19.1% of the statewide inventory, suggesting an undersupply in the geographic area, given that the district represents almost 30% of the statewide population. Currently, approximately 10% of these placements are vacant—statewide and in District 5—which is more likely due to the process of housemate matching and the availability of case management services to oversee placement than lack of demand. Other Medicaid Waivers The Medicaid program provides two other waivers that can be used by individuals with intellectual and developmental disabilities to help cover the costs of appropriate housing and the supportive services necessary to allow for sustainable residency within the community. The Family Supports Waiver (FSW) assists qualifying disabled children and adults finance up to $17,300 annually in services including case management, therapies and behavioral supports, environmental modifications and specialized equipment purchases, transportation and daycare programming. For children under the age of 18, household income is not a factor; applicants over the age of 18 must be found eligible for benefits from the Social Security Administration. Currently, there is a single statewide waitlist to receive funding for services under the FSW program; however, young adults 18-24 who have recently aged out of or 2 No information was provided by the state concerning waitlist demand for group home accommodations. Fishers Accessible Housing Report (Draft 4.1) 15 Page 38 of 46 graduated from the school setting and qualifying dependents of active-duty military and veterans are given priority placement without being placed on the waitlist. Currently, as shown on Table 11 shown on the following page, there are 22,586 Family Supports Waivers in use statewide and an active waiting list of 4,326. A separate data request to FSSA identified that 1,471 waivers currently in use within Hamilton County, but no information regarding wait list status within the County was provided). Statewide, almost 80% of those on the waiting list are under 18, with greatest level of unmet need for the assistance provided by these waivers in the 4-13 age group. Table 11: Family Supports Waiver Program - Individuals Served, Jan. 2023 Statewide % Hamilton Co Family Support Waivers 22,586 1,471 - Waitlist Total 4,326 Not published Waitlist by Age 0-3 years-of-age 407 9.4% - 4-5 years-of-age 1,073 24.8% - 6-13 years-of-age 1,587 36.7% - 14-17 years-of-age 381 8.8% - 18-22 years-of-age 369 8.5% - 23-34 years-of-age 174 4.0% - 35-44 years-of-age 196 4.5% - 45-59 years-of-age 82 1.9% - 60-69 years-of-age 46 1.1% - 70-79 years-of-age 8 0.2% - 80+ years-of-age 3 0.1% - Total 4,326 - Source: Indiana Family and Social Services Administration, Urban Partners Medicaid’s Community Integration and Habilitation (CIH) waiver similarly provides financial assistance to cover the costs of individualized supports that allow intellectually and developmentally disabled children and adults to live successfully in a community setting. This program is geared towards individuals who are transitioning out of institutional, supervised group home settings and children aging out of Department of Education and Department of Child Services programs and wish to live in the community. For adults those who have never been institutionalized, the eligibility requirements are quite narrow – limited to those individuals whose primary caregiver has died and no other caregiver is available, those whose primary caregiver is over 80 years old, and those who can document abuse, neglect or extraordinary health and safety risks in their current residence. In addition to case management and other health and therapeutic services, the CIH can be used to help cover rent and necessary residential modifications and can also be used to pay for rent and some per diem expenses for unrelated live-in caregivers, with Supplemental Security Income. As shown on Table 12 shown on the following page, BDDS reports a total of 9,047 CIH waivers in Fishers Accessible Housing Report (Draft 4.1) 16 Page 39 of 46 use statewide, with an additional 68 waivers designated as “Money follows Person”. 348 of the waivers in use are reported in Hamilton County (according to the separate FSSA data request). Table 12: Community Integration Habilitation Waiver Program - Individuals Served, Jan. 2023 Statewide Hamilton Co Community Integration and Habilitation Waiver 9,047 348 Community Integration and Habitation/Money Follows Person Waiver 68 Total CIH Waivers 9,115 Applications for Emergency Placement Waivers - Total 2022 Applications 565 - Number Approved: 178 - % Approved: 31.5% Health & Safety Concerns at Current Residence - Total 2022 Applications 434 - Number Approved: 85 - % Approved: 19.6% Abuse and Neglect Applications - Total 2022 Applications 18 - Number Approved 15 - % Approved 83.3% Caregiver Over 80 - Total 2022 Applications: 53 - Number Approved: 47 - % Approved: 88.7% Loss of Caregiver - Total 2022 Applications: 55 - Number Approved: 45 - % Approved: 81.8% Source: Indiana Family and Social Services Administration, Urban Partners No information about the general waitlist status for this program is available; however, data does exist regarding emergency placement for adults qualifying due to the circumstances identified above). In 2022, BDDS received 565 discreet applications for emergency placement and was able to approve 31.5% of these requests. The majority of these requests were from individuals experiencing health and safety risks at home, yet only 19.6% of these applications were approved. Although much smaller in number, the requests on behalf of individuals experiencing abuse and neglect or an elderly or recently deceased caregiver were approved at rates over 80%. Fishers Accessible Housing Report (Draft 4.1) 17 Page 40 of 46 In addition to statewide level data about specific waivers, BDDS identifies the total number of all waiver applications received from each of its eight service districts for the years 2020- 2022. As shown on Table 13, the percentage of total applications from District 5, which includes the greater Indianapolis area, roughly mirrors its portion of the state’s overall population, accounting for between 27.6 and 30.5% of applications during this period. There was a significant growth in demand for waivers between 2020-2022 statewide—with District 5’s waiver request level experiencing a 120% growth. Table 13: BDDS Waiver Applications by District 2020-2022 District District District District District District District District Total 1 2 3 4 5 6 7 8 2022 719 1,010 800 628 2,161 554 547 643 7,079 % of total 10.2% 14.3% 11.3% 8.9% 30.5% 7.8% 7.7% 9.1% 2021 639 909 855 603 1,981 530 458 571 6,546 % of total 9.8% 13.9% 13.1% 9.2% 30.3% 8.1% 7.0% 8.7% 2020 367 562 417 331 981 287 292 318 3,555 % of total 10.3% 15.8% 11.7% 9.3% 27.6% 8.1% 8.2% 8.9% % Growth in 95.9% 79.7% 91.8% 89.7% 120.3% 93.0% 87.3% 102.2% Demand 2020-22 Source: Indiana Family and Social Services Administration, Urban Partners Several non-profit organizations, including Opportunities for Positive Growth and Insights Consulting assist residents in the Indianapolis area with intellectual and developmental disabilities acquire Medicaid waivers, develop appropriate case management approaches and identify accessible housing and supportive services. Opportunities for Positive Growth estimates that they have assisted approximately 10 Fishers residents in the process of securing appropriate housing and a sustainable program of supports and that there are an additional 10-15 Fishers residents who are in need of their services. Because the housing stock in the City of Fishers is largely not accessible, most Fishers residents with intellectual and developmental disabilities requesting assistance locating appropriate housing and supports end up moving elsewhere in the region. Rental Housing Tax Credit Projects Fisher’s SouthPointe Village Apartments is the first development project in the State of Indiana financed using Rental Housing Tax Credits (RHTC) to include units set aside for individuals with disabilities. The development, which includes 62 one- and two-bedroom units, are rented to people earning between 30% and 80% of the area’s median income and includes accessible units reserved for disabled residents. Importantly, the RHTC application process required partnership between the developer, the property manager and organizations that will provide necessary services to the disabled residents who live at SouthPointe. Construction Fishers Accessible Housing Report (Draft 4.1) 18 Page 41 of 46 was completed in 2021 and the apartments have been occupied for less than a year, but already there is a waiting list of 80 people interested in the units designed for disabled residents. Figure 1: SouthPointe Village Source: Real America, LLC Lieutenant Governor Suzanne Crouch is a strong advocate for the intellectually and developmentally disabled community and, as Chairwoman of the Indiana Housing and Community Development Authority (IHCDA) which administers the RHTC program, has prioritized the development of housing for vulnerable populations. In 2020, IHCDA carved out a portion of its RHTC funding to administer the Moving Forward demonstration project. A charette process brought together teams of developers, property managers and service providers to brainstorm inclusive development projects that could successfully integrate individuals with disabilities into the community. After a request for proposals process, two projects were selected for funding—one in Indianapolis, the other in Carmel. As part of its 28- acre North End mixed use project, Old Town Companies will develop between 144 and 280 rental units for residents with incomes under 80% of the area’s median, of which between 20 and 48 will be reserved for disabled residents. This project is currently in predevelopment. Furthermore, the State’s 2023-24 Qualified Allocation Plan (QAP), which provides guidance about how RHTCs should be awarded, requires that 10% of annual RHTCs will be set aside for developments that integrate between 20-25% of their units to households having at least one member with an intellectual or developmental disability. As with the SouthPointe project and the Moving Forward demonstration effort, applications will require a plan for on-site resident Fishers Accessible Housing Report (Draft 4.1) 19 Page 42 of 46 services as well as details about transportation and other linkages to necessary off-site supports. Acknowledging that these projects are more complex than conventional income-defined rental housing projects, IHCDA has teamed with the Corporation for Supportive Housing, a national non-profit focused on improving the housing stability of vulnerable populations, to provide interested development teams with training through the Indiana Supportive Housing Institute. Each year, IHCDA plans to select five teams (which must include the developer, property management and designated service providers) to participate in this four-month training program in which each team develops an individualized supportive housing plan and service delivery strategy. Following completion, these teams can access RHTC financing and become eligible for other sources of pre-development, construction, and operating support. Other Physically Accessible Housing Very little development is geared specifically to individuals requiring accessibility solely due to physical disability. Federally subsidized affordable housing limited to those over the age of 62 is, however, typically designed to be physically accessible and is, at times, available to younger people with disabilities, regardless of age. The Central Indiana Senior Fund prepared a study “State of Aging in Central Indiana” in 2021 and reported that—using data from the National Housing Preservation Database—of the eight counties in the Central Indiana region, Hamilton County had among the least total number of affordable housing units for seniors at 38 and the least units per 1,000 eligible older residents at 40. The Central Indiana region as a whole has 100 affordable housing units per 1,000 To download the full State of Aging in Central eligible residents over the age of 62. Indiana report, click this link. Recognizing the lack of accessible housing overall, the IHCDA requires RHTC projects to exceed the federal ADA accessibility/adaptability requirements by at least 5%, resulting in more accessible units being created under the program’s current Qualified Action Plan guiding principles than those being reserved to meet in other supportive housing for populations with disabilities. Fishers Accessible Housing Report (Draft 4.1) 20 Page 43 of 46 Other Considerations This section is comprised of miscellaneous notes and information gathered from key stakeholder interviews and targeted research completed for this report. • Many problems associated with accessible housing have become exponentially worse in the last several pandemic years. High real estate values in Fishers make very difficult to compete in open market for this population; in tight market, landlords have very little incentive to share costs of unit modifications, even if tenant wants to try to use waiver funding to help cover a portion of cost. Rental rates at SouthPointe Village already raising in second year—a 2 BR at 30% median was initially $429 and is rising to $494 next year, even though subsidies are not going up. People receiving Supplemental Security Income are not allowed to have more than $2,000 in assets at any time, which makes virtually impossible to put a deposit on an apartment, even if pooling resources with multiple roommates together. Similarly, provision of those supportive services that allow Hamilton County and City of Fishers residents having disabilities to live successfully in accessible dwelling units have also been impacted during the pandemic, with case management positions and other therapy services significantly understaffed. • Within Hamilton County, accessible housing for IDD and populations with physical disabilities is considered by service providers to be most scarce within Fishers and Carmel—the two most affluent communities. Noblesville, as the county seat, has greater income diversity and diversity of housing stock, which these providers consider more easily adapted for accessibility. In general, it is usually quite difficult to create an accessible residence in an already built structure—ramps not always possible, hallways are not wide enough, and modifications to make bathrooms and kitchens accessible are often impossible because of space constraints and usually quite expensive. • Fishers also very difficult in that there’s not currently enough other structural supports to supplement family resources to help allow a family member to remain in their home. Examples include: o Lack of current day programming for families with IDD children after they finish high school near Fishers. o Lack of reliable public transportation to take IDD family member to day programming—users rely on family member having time/resources to make trip elsewhere in Indianapolis region (hours of day programming make holding a full- time job impossible). In the past, expensive housing market, lack of services, lack of ability to qualify for Medicaid waivers frequently resulted in families leaving Fishers for affordable markets Fishers Accessible Housing Report (Draft 4.1) 21 Page 44 of 46  where services were more readily available. Fishers is becoming responsive—the mayor is very supportive of special needs populations and has indicated willingness to gift space to Outside the Box, which provides day programming for 400 individuals in Indianapolis, to create a bridge program to provide day services to Fisher area IDD residents in the new community recreation facility. • While some with developmental/intellectual disabilities do not have physical mobility issues, preference is to access units with physical modifications because there is frequently overlap between IDD and physical disabilities. • Many stigmas need to be overcome about populations with disabilities that impact their ability to obtain/maintain housing, especially the IDD community. Overall, with appropriate case management and residential supports, they are excellent tenants. There’s a general sense that there’s less NIMBYism aimed at set-asides for accessible units than there is for affordable housing overall. • In 2020, the Corporation for Supportive Housing prepared the Medicaid Supportive Housing Services Crosswalk for the IHCDA, which examined how well the state’s application of various Medicaid waiver programs actually tracked individual’s needs. The study provided case studies of several individuals—a homeless woman with significant mental illness and a recently hospitalized older man who was in the process of being evicted from his apartment— and showed how difficult it is for vulnerable people to get through all of the necessary preliminary steps to apply for benefits that can help to cover the costs of housing, not even including the difficulty in locating appropriate housing and services themselves. These To download the full Medicaid Supportive included the lack of birth certificate/ID, need to Housing Services Crosswalk report, click this link. attend multiple psychiatric evaluations, transportation difficulties in getting to multiple appointments, etc. • Zoning remains a challenge in getting approvals for multi-family housing that can include units designed for disabled in many Indiana communities. Fishers Accessible Housing Report (Draft 4.1) 22 Page 45 of 46 • Data about the size and socio-economic characteristics of the population of individuals with physical, intellectual, and developmental disabilities —and about the specific needs for accessible housing and related supportive services amongst this population— is incomplete, both within Indiana and at the national level. The data that is available is difficult to piece together to develop a clear understanding of need since it is gathered by different sources using incompatible parameters (e.g., inconsistent age cohorts, income levels, geographic designations, etc.). Other types of data that would be useful to this analysis is not available due to privacy and equal protection concerns—for example, realtors cannot share the disability status of property owners or tenants under Fair Housing Act protections—and information relating to the quantity, characteristics and location of privately-owned housing units at which stakeholder organizations help place clients, is currently available at a piecemeal level, held individually by a large variety of service providers serving different clientele and active in different service areas. And, except for elderly residents who pay privately for assisted living or nursing home care (who are thus included in our survey of area elder care communities), no data is available about individuals with disabilities who require accessible housing and related supportive services who do not qualify for public financial support and are not identified by state agencies. Collectively, this dearth of available data makes it very difficult to adequately characterize and quantify the supply and demand characteristics for housing and related supportive services for a diverse population with a broad range of needs. Fishers Accessible Housing Report (Draft 4.1) 23 Page 46 of 46