National Church Residences

2. National Church Residences

3. The Challenge • This country is in a financial mess • The demographic changes will overwhelm us • People who need LTC will double by mid century • Welfare model not working • Medicaid is absolutely unsustainable

4. Paterson Says Schools and Medicaid Face Cuts SAN JUAN, P.R. — Gov. David A. Paterson said in an interview on Sunday that he would almost certainly seek billions of dollars in cuts to Medicaid, as well as midyear reductions in school aid, to address New York’s worsening fiscal condition.

5. ‘ “We’re not going to close a $12.5 billion deficit with 5 percent cuts to health and education.”

6. ‘Asked if the cuts for education and health care programs would be in the billions of dollars next year, he said, “Unquestionably.”

7. The Financial Challenge David M. Walker President and CEO The Peter G. Peterson Foundation and Former Comptroller General of the United States

8. Composition of Federal Spending 1967 1987 2007 Social Security Medicare & Medicaid Defense All other spending Net interest 9 Source: GAO analysis of Office of Management and Budget data.

9. Federal Spending for Mandatory and Discretionary Programs 1967 1987 2007 Discretionary Mandatory Net Interest 10 Source: GAO analysis of Office of Management and Budget data.

10. Revenues and Composition of Spending as a Share of GDP Percent of GDP Revenue Source: GAO August 2007 analysis. Notes: AMT exemption amount is retained at the 2006 level through 2017 and expiring tax provisions are extended. After 2017, revenue as a share of GDP returns to its historical level of18.3 percent of GDP plus expected revenues from deferred taxes, i.e. taxes on withdrawals from retirement accounts. Medicare spending is based on the Trustees April 2007 projections adjusted for the Centers for Medicare and Medicaid Services alternative assumption that physician payments are not reduced as specified under current law.

11. Growth in Spending for Social Security, Medicare and Medicaid Expected to Outpace Economic Growth Growth in constant dollars 2008-2033 Source: GAO analysis of data from the Office of the Chief Actuary, Social Security Administration; Office of the Actuary, Centers for Medicare and Medicaid Services; and the Congressional Budget Office. Note: GDP, Social Security and Medicare projections based on the intermediate assumptions of the 2008 Trustees’ Reports. Medicaid projections based on CBO’s January 2008 short-term Medicaid estimates and CBO’s December 2007 long-term Medicaid projections adjusted to reflect excess cost growth consistent with the 2008 Trustees intermediate assumptions. 12

12. Social Security and Medicare’s Trust Funds Face Cash Deficits Billions of 2008 dollars Social Securitycash deficit 2017 Medicare HIcash deficit2008 2017 Source: GAO analysis of data from the Office of the Chief Actuary, Social Security Administration and Office of the Actuary, Centers for Medicare and Medicaid Services.Note: Projections based on the intermediate assumptions of the 2008 Trustees’ Reports. The CPI is used to adjust from current to constant dollars. 13

13. The Challenge • This country is in a financial mess • The demographic changes will overwhelm us • People who need LTC will double by mid century • Welfare model not working • Medicaid is absolutely unsustainable

14. Projected Number of Elderly with Disabilities More than Doubles Decline in disability rates has less effect than growth in numbers of elderly

15. 20% institutional setting 80% at home Where Is Care Provided?

16. Conclusion • We need solutions that are: • Lower Cost • Improve outcomes • Improve consumer satisfaction • The Solution: Empowering communities for successful aging

17. National Church Residences perspective

18. NCRWhat influences our thinking? • 50 year history • Bristol Village • 23000 units of affordable housing • 200+ Service coordinators • Nursing Homes & Assisted Living: we know about facility based care • Supportive housing for the homeless • Governance that wants to make a difference

19. Bristol Village Founded 1961

21. Bristol Village 1961

23. Founding Churches

25. Bristol Village: Creating the Best CCRC value in America

26. NCR Affordable Housing

27. 23000 units

28. 200+ Service Coordinators

29. NCR HealthCare Traditions… of Chillicothe at Bath Road at Stygler Road at Mill Run

30. What we concluded • We are serving the most vulnerable part of our society • Our residents are inexpensive now but staggering cost elsewhere in the system • Demand for affordable housing exceeds supply

31. What we concluded • Existing models are too expensive • There are clues to the future • CCRC • Supportive Housing for the Homeless • Illinois model • Affordable housing is a gem

32. $1600 $400 $180 $100 $25 $1 Hospital Medicare Nursing Home Assisted Living Housing Service Coordination Meals ? Transportation ? The numbers

33. Clues to the future • Supportive housing for the homeless

34. Commonsat Grant Permanent Supportive Housing for the homeless

35. Permanent Supportive Housing for the homeless

37. Commonsat Grant Super Service Coordination Permanent Supportive Housing for the homeless

38. Illinois Affordable Assisted Living

39. Illinois Model

40. Illinois Model

41. Illinois model

42. InCareServices for Seniors-Choices for Living NCR HealthCare NCR Housing NCR at HOME

43. Experimenting with solutions • PODS • Integrated campuses • Building to a new model of care

44. New Ideas • Super Service Models • Affordable Assisted living • PACE • PACE-Lite • Doctor on Campus • Collaborations

45. But mostly we are really going to focus on affordable housing • Affordable housing is a gem • Expand it! • Preserve it! • Enhance it!

46. Expand it!

47. Laurels of JunaluskaSponsor: Givens Estates $3.3 million 100 units Fee managed Waynesville, NC

48. Preserve it!