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Spotlight: A Conversation with Mohini Mishra, Selfhelp Realty Group| The Melamid Institute for Affordable Housing Vice President, Housing Services

Selfhelp was founded in 1936 to help Jewish refugees fleeing Nazi Germany. Today, Selfhelp has grown into a large human service and housing provider, providing care to older adults across New York City and Long Island. In its senior affordable housing residences, the organization uses an innovative model of care, called the Selfhelp Active Services for Ageing Model or SHASAM, that emphasizes the social determinants of health and has been found to help significantly improve health outcomes. Throughout the pandemic, the SHASAM proved to be vital in equipping Selfhelp to be well prepared to assist its residents, giving them the tools they needed to ensure resident safety during the pandemic and maintain as much normalcy amidst the uncertainty.

The National Housing Conference spoke with Selfhelp Realty Group| The Melamid Institute for Affordable Housing Vice President, Housing Services, Mohini Mishra, to learn more about how the organization adapted its practices and helped ensure compliance with pandemic restrictions, all while retaining resident autonomy.

Tell us about the communities you serve. Who are your residents and where do they come from?

Selfhelp was founded to serve Jewish refugees from Nazi Germany, who in the 1930s were arriving in New York en masse and had very little social capital to find their footing. Initially, our organization focused on providing job training and referrals for housing to emigres. However, as the population we served began to age, we decided to begin providing housing to older adults ourselves, and we opened our first residential building in 1964. That building was initially built for  Holocaust survivors, but in order to ensure our eligibility for federal funding under the 1965 Older Americans Act, we opened our buildings to all seniors in need shortly thereafter.

Today, we operate 14 senior buildings with 1,400 residents ranging in age from 62 to 105. Our residents are extremely diverse, with only 10% speaking English as their first language, and large populations of Chinese, Korean and Russian speakers. Throughout Selfhelp, we provide Holocaust survivor services, home care training, home care, guardianship services and operate several senior centers (including a virtual one for homebound seniors), services that reach over 20,000 people a year.

Selfhelp uses a service provision model called SHASAM. Can you explain what this model entails?

At the foundation of the SHASAM model is the finding that 80% of a person’s well-being is determined by things that happen outside a clinical setting – a person’s social determinants of health – and that perhaps is the most important social determinant of health is social connection. Accordingly, SHASAM focuses on maintaining a social connection for the seniors in our buildings and ensuring that they are able to remain in our buildings no matter what health issues they encounter as they age. Our social workers are key to this model. They work on-site at each of our buildings and work to facilitate connection among our residents by organizing activities like walking clubs and mahjong classes.

Our social workers also work to build community among residents by connecting new move-ins with resident leaders who share a similar cultural and linguistic background. We know that it is vitally important for people to have access to culturally affirming goods, services and relationships, so we take very seriously the task of connecting new residents with people who can show them grocery stores that carry products they will be familiar with or places to access faith services they might be interested in.

Of course, we also recognize the importance of clinical care, and we provide referrals to healthcare services to all of our residents, as well as all of the social services already described. The key for us is that our residents always feel that they are able to choose whether to access these services, rather than have them foisted upon them and that no matter their level of need they are always able to stay in our buildings where they have built connection and community. We refer to this as ensuring that residents are allowed to age on pace, as well as age in place. A recent research paper, funded by NHC member JPMorgan Chase, found that Selfhelp residents experienced better health outcomes and submitted fewer claims to Medicaid and Medicare than comparable groups, affirming the success of our model and contributing to the growing literature on the effectiveness of housing and community for health outcomes.

One of our points of pride is that less than 2% of our residents are transferred to nursing homes during any given year. On Long Island, it costs on average $143,000 a year to keep one person in a nursing home and provide the clinical care that determines 20% of their overall wellness. That is almost exactly how much the SHASAM model would cost, which would include one of Selfhelp’s onsite social workers, who coordinate access to the social determinants of health that determine 80% of wellness and do it for an average of 80 residents. The fact that less than 2% of our residents move from our buildings to institutionalized settings in any given year is a testament to our ability to provide for their clinical needs while keeping them in the communities they love.

How did the SHASAM model fare during COVID-19?

At the core, the SHASAM model is one based on building trust, both among residents and between residents and Selfhelp employees, especially our onsite social workers. That trust proved invaluable when the pandemic hit and made it necessary to coordinate the activities of our residents in a way that would minimize risk for all of them. We all remember how confusing it was at the beginning of the pandemic; how unclear it was what was safe and what wasn’t, and how guidance on masks seemed to change with the week. That confusion was all the more acute for our residents, who knew they were at higher risk of developing complications from the virus and who often do not have access to traditional media sources due to language barriers. That sort of confusion could have generated mistrust and suspicion, but thanks to the trust we had built with our residents, we had the credibility to ask them to take the extraordinary measures that were necessary to keep everyone safe during the first several months of the pandemic and provide them with information they knew they could trust.

At the beginning of the pandemic, our social workers were in constant communication with each of our residents in order to break down the most recent CDC guidance and answer questions they had about new safety protocols, such as lockdowns and the closure of common areas. We also partnered with nursing students who were able to answer resident questions that were more healthcare or science-specific, as well as occupational therapy students who were able to answer questions about stress management.

Our residents’ trust in our staff was also crucial in ensuring that they were connected with the sorts of services that were necessary during the pandemic. It can be difficult for many people to admit when they need help, and so the culture of trust and vulnerability that we have cultivated helped us ensure that no one went without during this time. For example, going into the pandemic we knew that 55% of our residents did not have home care aides who would have helped them with meal preparation and purchasing food. As local grocery stores started to close and residents began to avoid higher-risk activities such as shopping for food, we were able to connect residents who needed it with nutritional assistance services. This effort allowed 100% of our residents to receive some sort of nutritional assistance during the pandemic.

Throughout the pandemic, we have emphasized that social distancing is something of a misnomer. What’s required to beat the pandemic is physical distance, but physical distance need not entail a decrease in social connection at all. To that end, we worked hard to make sure our residents stayed connected with us and with each other during the pandemic, such as through creating a virtual happy hour for residents and leveraging existing virtual infrastructure that we used to provide services to homebound seniors before the pandemic. Again, it’s only because of our residents’ high level of trust in us that we were able to get them engaged in these sorts of activities and keep them healthy.

We’ve heard from other senior living providers that it was initially hard to communicate with residents when we entered lockdown, since face-to-face interaction was limited and many residents found it difficult to communicate using cell phones or the Internet. Did Selfhelp encounter similar challenges?

The key thing to understand about our SHASAM model is that it entails frequent communication with each of our residents no matter what. That means that despite some obvious changes to our work during the pandemic – staff being remote, coordinating lockdown procedures, etc. – the communication aspects of our work didn’t change all that much. We were already in consistent communication with our residents, and we had already ensured that we could get in touch with each of them remotely were there to be an emergency that prevented us from being on-site, such as a hurricane or blizzard.

We have also cultivated a network of resident volunteers in each of our buildings, who help keep us updated on the well-being of their neighbors. Though we had to coach them a bit on how to go about checking up on their neighbors while limiting face-to-face contact, having that network in place made it far easier for us to ensure all our residents remained safe and healthy even when we had trouble getting in touch with them remotely. If we hadn’t been able to contact a given resident in a few days, we could always call our dedicated resident volunteers. Nine times out of 10, that person would say that they’d seen that resident in the laundry room or walking down the hall a few days ago, and that they seemed just fine. The biggest difference during the pandemic is that we used these sorts of remote capabilities for far longer than we ever had before.

How did the SHASAM model help to facilitate vaccine uptake?

The SHASAM model emphasizes self-determination, and so we have been careful to emphasize that vaccination is a personal choice that each of our residents needs to make for themselves. This framing is especially important for our clients, because many of them come from backgrounds that make them skeptical of government-sponsored health initiatives, and so attempting to force or pressure them into getting the vaccine would erode their trust in us and probably be ineffective at increasing vaccine uptake anyway.

That being said, we have tried to leverage our residents’ trust in us to act as a dependable source of information on the vaccine, just as we did during the beginning of the pandemic when we acted as a trusted source of information on CDC guidance. We’ve been discussing the vaccine with residents since October of last year, letting them know that vaccines were coming and that we were available to answer any questions they might have about it.

Another way we increased resident vaccine uptake without coercion was by creating a vaccination site by partnering with a federally qualified health clinic located on the first floor at one of our buildings. Having a vaccination site at one of our properties helped increase residents’ trust in the vaccine since it no longer seemed like something a far-off government was pushing but rather something that was in collaboration with Selfhelp, an organization our residents trust. Using these sorts of methods, we were able to get our vaccine acceptance rate above 80%. While some might be skeptical of the fact that we got to that number by emphasizing the voluntary nature of getting vaccinated, we think it makes perfect sense: people respond best to being treated as capable and intelligent, and since the balance of the evidence is on the side of getting vaccinated, we knew that simply presenting the pros and cons of vaccination to our residents and allowing them to make their own decision was the best route forward.

How is Selfhelp taking concrete steps to actualize the lessons it learned from the pandemic?

We think that the pandemic proved the effectiveness of SHASAM’s emphasis on using housing as a base to provide services to people, rather than changing people’s housing depending on the sorts of services they need. We think that this affirmation of our model’s success is a great reason to look to expand, and so to that end, we have created an affiliate entity called Selfhelp Realty Group, that focuses on efforts to build more senior affordable housing. Building off the success engendered by the research paper on our model, we have also leveraged funding from Holocaust survivor Ilse Melamid to enhance these efforts through the Melamid Institute for Affordable Housing, which will help us spread our model by growing our capacity in New York and beyond. The institute will act as the primary entity for development, building Selfhelp Realty Group’s capacity to pursue real estate opportunities and Selfhelp’s administrator’s ability to provide services to residents in existing buildings. The Institute will ensure we are able to continue what we do best while spreading the word about our approach and expanding our ability to provide services to the population we serve.

Spotlight: A Conversation with Oji Alexander, Executive Director of Home By Hand

The COVID-19 pandemic has thrown countless households across the country into a crisis, with decades-high unemployment figures, unexpected health costs and the shuttering of local businesses. Renters are particularly vulnerable to the effects of this crisis, unable to fall back on the stability provided by homeownership. The ability to accrue equity over time and access forbearance and loss mitigation options are just a few of the larger benefits of homeownership that come together to form a financial safety net for homeowning households. 

Helping minority and low-income households, who often face more obstacles to homeownership, become mortgage ready and purchase an affordable, quality home has been the goal of Home by Hand long before the onset of COVID-19. This New Orleans based nonprofit affordable housing developer has been helping individuals and families tap into the financial stability provided by homeownership – benefits that are clearly underscored in today’s uncertain environment. 

The National Housing Conference spoke to Home by Hand Executive Director Oji Alexander about how the organization and the people it serves have been affected by COVID-19 and why their affordable homeownership mission is as important as ever. The discussion has been edited and paraphrased for brevity. 

Homeowners in front of their new houses built by Home By Hand in 2019

What is Home by Hand’s mission?

Recognizing the powerful wealth generating effects of homeownership, we at Home by Hand strive to create affordable homeownership opportunities for low- and moderate-income New Orleanians. Whether through new construction or the redevelopment of vacant and abandoned homes, the organization plays an active role in building neighborhoods of opportunity throughout the New Orleans area.  

Relying on a network of partnerships across lenders, contractors, architects, and state and local agencies, such as Crescent City Community Land Trust (CCCLT) and the New Orleans Redevelopment Authority (NORA), our program is designed to maximize development and lending opportunities for the construction and financing of affordable homes for families and individuals who may not otherwise have an opportunity to purchase a home. Every year, we build between 10 and 15 homes that are sold to eligible low- and moderate-income homebuyers.

How does that mission serve the community? 

Particularly in the wake of an unprecedented global pandemic and civic unrest, our work to reduce racial inequality and slow the conversion of homeownership housing to rental housing plays an important role in stabilizing and revitalizing local communities. 

A historic lack of reinvestment capital into low- and moderate-income neighborhoods has exacerbated racial inequalities in homeownership and household wealth over time. This lack of investment has created a favorable environment for large rental portfolios that purchase foreclosed homes and convert those homes into often poorly-maintained rental housing, undermining quality of life and contributing to declining property values. Home by Hand is working to combat this trend by investing in quality affordable homeownership housing across multiple neighborhoods in New Orleans. 

We often work with households that already rent in the neighborhoods where we are developing homes; this advances our goal of keeping communities in place. By relying on a pre-sale homebuying model, we are able to serve a demographic that would otherwise be outcompeted in the housing market. 

How does that mission serve local households?

Our program, which places 10 to 15 individuals and families into quality, affordable homes every year, demonstrates the value and often-overlooked affordability of homeownership, particularly in areas of the country like New Orleans. We consistently maintain a robust pipeline of over 100 applicants – a testament to the unwavering demand for affordable housing from households throughout the area.  

Harvard University’s Joint Center for Housing Studies reports that New Orleans renters find themselves just as cost-burdened as renters in notoriously expensive markets, like Los Angeles. The affordability of homeownership compared to the relatively high cost of renting in New Orleans adds to the long list of benefits traditionally associated with homeownership, which includes tax advantages, the accrual of home equity, stronger community ties, greater civic engagement, lower crime, improved academic performance and better health outcomes. 

While the global pandemic has shaken the economy and healthcare system, the safety net provided by homeownership remains available to homeowners who may be able to tap into equity or lower their monthly mortgage costs through refinance. Homeowners also have the option to work with their mortgage servicer if they’re unable to make their mortgage payments. This stands in contrast to renters unable to pay their rent, who have fewer remedies to reduce monthly expenses and are more likely to face eventual eviction.  

New Orleans Housing Affordability At-A-Glance 
Salary required to purchase a home at the median sales price with a 10% down payment in New Orleans in 2019$45,000
Salary required to purchase a home at the median sales price with a 10% down payment in US in 2019$56,000
Share of cost-burdened renters (paying more than 30% of income on rent) in New Orleans in 201856% – 63%
Share of cost-burdened renters in US in 201847%
Average share of cost-burdened homeowners in New Orleans from 2014 – 201834%
Source: National Association of REALTORS®, Harvard’s Joint Center for Housing Studies and HousingNOLA 

How has COVID-19 impacted the organization’s operations?

As far as physical operations, we were well-positioned to transition to working from home. From a strategic standpoint, however, our team had to pivot to new areas of need brought on by the pandemic. 

We were able to stabilize our cash flow by applying for a Small Business Administration (SBA) Paycheck Protection Program (PPP) loan. The funding, quickly provided by a small local bank, was a life saver.

With residential construction identified as an essential service, we were able to stay largely on schedule with our construction projects. Conversely, we experienced major disruptions in the usual financing process.

How has COVID-19 changed how the organization works with prospective homebuyers?

Home by Hand uses a pre-sale side model of homebuying, coaching prospective homebuyers until they are mortgage ready and engaging in homeowner education. We help prospective homebuyers improve their credit scores and build their savings in advance of beginning the mortgage process. 

Once program participants are mortgage ready, we work with a few specific lenders, predominantly smaller local banks, whose underwriting and lending criteria can accommodate our participants and unique financing model, which usually combines a Federal Housing Administration (FHA) insured mortgage, subsidies, and a forgivable third mortgage.   

The pandemic, however, shifted our immediate focus to those individuals and families in the midst of the mortgage underwriting process, as well as to existing homeowners that we have worked with in the past. 

At the onset of COVID-19, we had four homebuyers ready to close on four of our properties. All four buyers were impacted by the economic fallout of the pandemic and lost their jobs. Three of the borrowers eventually regained employment and were able to resume the mortgage process and purchase their home. One of the buyers, however, was disqualified because of the tightening in underwriting that resulted from changes in the larger economy. 

As homebuyers moved to the contract signing stage, we were concerned about people’s willingness to sign contracts remotely, but this did not pose an issue for any of the homebuyers. 

How has COVID-19 changed how the organization works with existing homebuyers?

Home by Hand’s homebuyer education model typically provides all of the post-sale information that homebuyers need before the purchase occurs. From maintenance recommendations, termite seminars and post-sale stewardship guidance, homebuyers that work with us are usually amply prepared for responsible homeownership. 

COVID-19 has redirected more of our efforts to our recent homebuyers. We are creating new resources to educate homeowners on how to convert their wealth and equity into usable income and directing homeowners to other valuable outlets for helpful information and guidance. We have reached out to all of our recent homebuyers to see if they are still employed or have difficulty making payments and are working diligently to prevent any foreclosures. 

Are there any lessons to be learned from COVID-19 and its impact on households?

Although so much has changed over the past few months, one thing has not: the need for affordable homeownership opportunities, in New Orleans and in communities across the country. COVID-19 has revealed that those households without wealth, in the form of home equity or financial savings, are far more at risk and lack a financial safety net. 

Investing in constructing and rehabilitating quality homes, preparing households for homeownership, and connecting homebuyers to creative, but responsible, financing options can have a profoundly positive impact on the long-term financial stability and overall well-being of individuals and families and the communities they live in, ensuring they are able to weather this pandemic, as well as future crises. 

As life slowly returns to normal, we at Home by Hand are continuing to advance our mission. We have 13 new energy-efficient, storm-resistant construction projects underway and are accepting applications for 10 new homes.

Spotlight: A Conversation with Laura Andes and Kate Peterson, Mercy Housing’s Senior Vice Presidents of National Resident Services and Communications

As one of the nation’s largest affordable housing organizations, Mercy Housing is a leader in the development, preservation, management and financing of service enriched, affordable housing for low income households across the country. 

Mercy Housing’s commitment to service enriched housing stems from their belief that people need more than just a place to live to have a stable life. As a result, they have built a strong resident services platform to provide a wide array of programming for residents to help improve their health, wellness and financial stability.

At the start of the COVID-19 pandemic, Mercy Housing quickly leveraged its resident services platform to provide critically needed assistance specific to the needs of the residents in their properties across the country.

We chatted with Laura Andes and Kate Peterson, Mercy Housing’s senior vice presidents of national resident services and communications to discuss some of their best practices and lessons they have learned during the pandemic. The following is our conversation edited for brevity.

How did having an existing resident service platform help you respond quickly to the pandemic?  

Immediately, we began a program where our resident service staff called residents on a daily basis. Having an existing platform meant that our staff had existing relationships with the residents prior to the pandemic. That mattered a lot because people were more likely to pick up the phone and more likely to open up and talk about what was going on in their lives. These conversations allowed us to develop a better understanding of emerging needs so that we could respond more quickly to the immediate and sometimes unique needs of each property. It was also hugely important for many of the senior residents to remain connected during this period of social isolation.

What were some of those immediate needs and how were you able to respond?

Mercy Housing staff preparing to distribute food at one of their seniors housing properties

Because we have so many properties in California and Washington, we began to adjust programming in late February to early March. We immediately stopped all in-person programs, closed down community rooms and began our phone outreach program where we quickly learned that the most immediate need was food insecurity. Because we could quantify this need so quickly, we were able to receive emergency funding from private donors and foundations to buy more food. In Seattle, we worked with local restaurants to purchase their unused food and later scaled up this initiative through a partnership with Bank of America. Additionally, our relationship with Microsoft led to them donating meals that would have normally been prepared [in] their cafeteria to us.  

Read more about how partner organizations are helping Mercy Housing fund their food insecurity efforts here.

As you continue to stay in touch with residents, how have you been able to adjust your services to support their needs?

Once layoffs started occurring, it became clear to us from our phone calls that residents were going to need help obtaining unemployment insurance, stimulus payments and extended SNAP benefits.  We were able to get our resident service staff members the training they needed to help residents access those benefits as quickly as possible.  

Has the pandemic highlighted any areas that you would like to focus more on going forward?

Accessing digital technology has been a huge challenge. We have computer centers at many of our properties for residents to access the internet. When we shut those down, many of them lost their ability to go on-line. The digital divide has had an impact on all residents, especially school-age children who have now transitioned to remote learning. We are working to identify which children need computer and Wi-Fi access so that they are able to keep up with their schoolwork.  

Read more about how Mercy Housing is enabling digital access for their residents.

How have your partnerships elevated your work?

Having an existing resident service platform meant that we had already built many community and business partnerships in the towns and cities we operate in. It was pretty remarkable when the pandemic broke out that those partners said, “how can we help?” before we said, “can you help us?”

How have your staff and residents adapted to changes?

The creativity and innovation of our staff has been incredible. In one senior property, our staff organized “hallway bingo” games where residents sit in their doorways and play. Some are doing balcony singalongs. Our Out-of-School Time (“OST”) program has an Instagram feed and they’re putting daily recorded videos on their Instagram feed for their kiddos to do. We are now seeing residents who never showed up to programming before participating, allowing us to develop relationships that maybe wouldn’t have been formed prior to the pandemic. We take that engagement in our programs as one more sign that the work we are doing is making a difference.

Three takeaways and a challenge

Having an existing resident service platform across their properties is helping Mercy Housing respond more quickly to the needs of their residents during the COVID-19 pandemic.  Specifically, this has allowed them:

  1. Leverage the trust they established between staff and residents prior to the pandemic to engage more deeply with their residents.
  2. Building off their existing relationships with community service providers to help provide funding and services needed at the properties.
  3. Utilize data collection to make it easier for them to assess, track and quantify the need for services and grant funding.

One of the biggest challenges Mercy has faced is providing digital access for residents.

In addition to being an NHC member, Mercy Housing is also a member of the Stewards of Affordable Housing for the Future (SAHF) and has worked with other SAHF members to build a certification program for resident service providers.  For more information about building a resident service platform, visit the CORES website.

If you’d like to learn more about Mercy Housing Resident Services, click here. You can also listen to Cinnaire’s podcast interview with Mercy Housing on how they are responding to COVID-19 here.