New Hampshire Supportive Housing Toolkit
​
Housing Operations

A) Tenant Selection

The Visions Experience: 
​Tenant Selection

We maintain a waitlist.  For the moment, we lack capacity to add residents. 
Because we work from our own waitlist, we don’t respond to RFPs.  In the future we should be more involved with that process to better understand the need, to be a face at table, to keep the area agency aware that there are providers in the area. 
​
At Visions, a prospective resident will typically try out the setting through respite, for example one weekend a month over a period of time.  Everyone needs to be compatible – it’s a home.  We bear in mind maintaining balance in level of independence – that’s part of what makes a model work economically.  It influences how the house feels, especially the ability of more independent residents to help care for individuals needing more intensive support.

B) Leases, Lease Enforcement, and Rent Collection

The Visions Experience: 
​Leases and Rent Issues

Each Visions resident has a lease (a “Resident Agreement”).  A lease providing for anything short of the rights a renter without disabilities would enjoy will not fly under current regulatory requirements.
​
We have not experienced collection issues.  However it is important to include the risk of interrupted benefits in maintaining a sufficient financial reserve.

Each Resident Agreement includes provisions for termination, but as a practical matter it can still be hard to remove a resident whose guardian is dissatisfied.  Visions has had to do it.  Another provider recently had to go to Superior Court to get a resident out. 

C) Reasonable Accommodations in Supportive Housing Operations

The Visions Experience: 
Reasonable Accommodations

Ensure that needs for accommodations are communicated upfront and that the provider is equipped to handle the needs of the individual.  Reasonable accommodations are not limited to merely physical requirements, but can take many forms, including cognitive, behavioral, and medical.

D) Safety and Security

The Visions Experience: 
Safety and Security

At Sunrise Farm, we do not use a sign in-sign out system, nor have we installed alarms.  This does limit us with respect to certain behaviors, as we couldn’t presently accommodate an individual with an issue such as wandering.  In the setting we plan to open in Lebanon, we hope to be able to support individuals with dual diagnoses.

​The current rehab at Sunrise Farm is adding two major new safety features.  First, an automatic direct dial system which will contact the local fire department if an alarm is triggered on the property.  Second, a solar array, which will cut utility costs by an estimated $48,000 per year, with a battery back-up system to ensure power availability in the case of a grid interruption.  

E) Staffing Issues

Under New Hampshire regulations, prior to hiring or contracting with a person to work in a community residence, the provider agency must:  obtain at least two references for the person; submit the person’s name for review against the registry of founded reports of abuse, neglect, and exploitation; complete a criminal records check to ensure that the person (and all adult household members) has not been convicted of a felony or a misdemeanor involving certain kinds of conduct; and complete a motor vehicles record check to ensure that the person has a valid driver’s license.[1]
 
Hillsborough has an RN on staff.  Most clients self-administer and the RN meets with them regularly to ensure compliance and safety.  The RN contacts are anticipated in, and funded through, each individual’s DD Waiver budget.
View Footnotes
[1] He-M 1001.03 (g)(3).

The Visions Experience:
Staffing Issues

It’s essential to have some staff with experience in the BDS system; there would be a huge learning curve otherwise.  Ideally this would be the Executive Director, or Program Director, whomever is going to negotiate contracts.

For hiring staff, perform a search, solicit resumes, and cut down to three candidates.  Then introduce the candidates to residents and to guardians.

There are pros and cons to hiring staff to live-in as opposed to come in to work shifts.  At Sunrise Farm, we considered live-in staff, but were concerned with burnout and wanted the space to be the residents’ home, not the staff’s home.  Shift staff are more of a hassle administratively,  but come in fresh.

Hourly pay rates for direct support workers are a challenge for us, as they are across New Hampshire and throughout the U.S.  The maximum reimbursable direct support hourly rate in New Hampshire is $12.87.[1]  There has not been a cost of living increase for direct service providers in twelve years.  To fill the positions, the rates we actually pay for direct support currently range from $15 to $18 per hour.  We are able to pay those rates in part by not subsidizing health insurance for any of Visions’ employees (including the Executive Director).  Our funding includes a category for subsidizing employee insurance, but we have found the workforce is more responsive if that funding goes directly into the hourly rate.  We support ongoing advocacy seeking to raise the reimbursable rate to $15 per hour.  If the State bumps the rate to $15 per hour, then we hope to be able to offer benefits.  Group rate health insurance is available to Visions through the NH Center for Nonprofits, but the costs are presently still too high given the reimbursement structure.

To staff overnights, we pay $180 per shift for a fifteen-hour “asleep overnight” staff person, who prepares dinner and evening medications and supports two residents in the main house with night routine.  The staff person is on call for all residents living on the property and is woken as needed, typically once or twice overnight to assist a resident. If more support is needed, an on-call system is activated. The position wakes residents in the morning, assists with medication and breakfast.  Additional staffing comes in at 8am.

At Visions, the positions of Executive Director (Sylvia), Visions’ administrative assistant, and the program director positions are all theoretically funded 100% through the administrative portions of individual service budgets.  Dave Dow, who manages the property at Sunrise Farm, was initially unpaid and today is a part-time employee, working twenty hours per week.  That salary is funded out of mixture of the administrative portion of individual budgets and individual room and board payments.  The position of House Manager at Sunrise Farm is funded neither through the administrative portion of individual budgets, nor out of room and board payments, but through an allocation in each individual service budget.  The House Manager serves as the Employment Specialist, which helps to fund the position (there is separate fee in each service budget for House Manager and Employment Specialist).  As first conceived, the House Manager was the direct supervisor of direct service providers.  Now the Program Director does certifications, the House Manager oversees residents’ schedules, works directly with staff to ensure programs are compliant.  Finally, the costs of ARIS Solutions (payroll) comes out of the administrative portion.

Note that an executive director in this sector might expect to receive $60,000 to $80,000 per year, plus benefits. 

Visions continues to evolve as an organization and our staffing patterns and titles continue to evolve as well.
View Footnotes
[1] Approval of higher rates can be sought where a specialized client need can be offered as justification.

F) Maintaining the Physical Plant

The Visions Experience:
Maintaining the Physical Plant

At Sunrise Farm, Dave Dow is able to maintain the property working twenty hours per week.  As noted elsewhere, Dave’s expertise as an experienced contractor absorbs a lot of what might otherwise be significant costs, as does his relationships with local subcontractors.
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With respect to periodic expenses (like replacing a roof) over time we will build capital reserves.  For the moment, we have to seek grant or loan funding.  Our recently-closed mortgage funding from NHFFA is designed to catch us up on such pending repairs and leave us ahead of that game once the work is completed.

The Visions Experience:
Operations Issues Generally

Residences for the developmentally disabled in New Hampshire must be either licensed or certified.  Sunrise Farm requires Certification only, as Licensing is only required for residences of three or more residents per unit.  Licensing is designed with more medically acute settings in mind, such as hospitals and nursing homes.  Annual certification inspections are performed by the Community Residence Certification Unit of the Health Facilities Administration in the New Hampshire Department of Health and Human Services.

There are all kinds of obligations which arise if your setting requires licensing.  For example, a licensed setting can trigger staff credentialization requirements. 

 At Sunrise Farm, there are only two residents in the main house, plus a respite bed (which we currently use for individuals on our waitlist, typically one weekend each month.)  The other spaces are individual apartments.  The same will be the case for our planned residence in Lebanon:  ten residents, but each in an individual unit.

Bear in mind the related issues presented by the Settings Rule.
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Fire regulations and inspections are another important consideration.   The regulations are statewide, but inspection and enforcement is local.  It’s essential to communicate with local authorities to understand how the regulations apply to your setting and what changes might resolve any deficiencies.

G) Housing Operations Budgeting

The Visions Experience:
Housing Operations Budgeting Issues

Individual monthly rent at Sunrise Farm is now budgeted at a range of $638 to $1,022 depending on the income of the resident.  Generally this amount is covered by SSI. 

This doesn’t cover actual costs, and the balance must be addressed through fundraising. Real actual expense varies year to year due to one-time repair costs, new vehicles, new staff, etc.  This is why grants are necessary for ongoing operations, at least with respect to periodic repairs and enhancements.  Some on-going grants do contribute to normal operating costs.

If you had no mortgage, it might be possible to operate a residential setting on a very tight budget relying solely on streams from Medicaid, SSI, and § 8 (or §811).  Without the § 8 housing subsidy, you could scrape along with about $540 per month per resident, under current conditions (again, assuming you were carrying no debt). 

​Currently Visions does not have an office (or expenses) separate from Sunrise Farm.  Once Visions opens another setting, we expect it will have a local office.  

1) Potential Expenses

​Potential operating expenses to consider include:  fees if an outside agency performs any management  functions; payroll, health insurance and other benefits for on-site personnel; utilities including telephone, fuel, electricity, cable and internet; maintenance of the physical plant, grounds-keeping, and trash removal; legal, accounting and audit costs; insurance; advertising/outreach; and office and facility supplies.

The Visions Experience
Payroll Costs

We made a conscious decision to subcontract out all our bookkeeping to ARIS Solutions.

They had the tools and the specialists to do everything for us, allowing the Executive Director to concentrate on developing the business.

And their cost for performing our Payroll, Accounts Payable, and General Ledger functions was much less than the cost would have been of our doing them ourselves.

​This was part of our strategy of keeping administrative costs as lean as possible, as well as avoiding personnel complications.

The Visions Experience:
Legal Costs

There are predictable legal costs, such as in closing on purchasing or financing property, but also unpredictable ones specific to supportive housing.  For example, Visions incurred unanticipated costs when conflict with an individual’s guardian led Visons to have to have that individual move out. 

The Visions Experience:
Audit-related Issues

Audit costs for us average $6,000.  Funding entities may expect you to complete an audit every three years, after five years of existence.  Other funders require that you have done an audit in the prior year.  (There are lots of other grantor prerequisites.  Be prepared!)  To be in good standing as a non-profit with the New Hampshire Secretary of State requires annual financials (which do not have to be audited).  The IRS requires that a non-profit make public its 990s from the three most recent years (IRS Form 990 is:  Return of Organization Exempt from Income Tax).

The Visions Experience:
Insurance

Insurance is a significant expense.  We’ve found it worthwhile to meet with our broker more than once a year, irrespective of any claims, just to maintain and continually adjust coverage.  Workman's Compensation is 3.7% of base pay.  Sunrise Farm operates two vehicles rather than have staff use personal vehicles to transport residents.  We maintain property and liability coverage.  Maintaining Directors & Officers coverage is common sense and required for many grants.

H) Operations Financing

1) Allocating Housing Expenses to Individual Residents

The Visions Experience:
Monthly Resident Fees

While rents change, it may be helpful to consider that Visions recently charge $700 per month.  This figure was based on $678, which is the state approved residential fee using funding through Social Security.   Visions had decided to round this figure to $700 per month to include some of the cost for TV and internet.

The actual cost for renting a room/suite is $600 a month, which is the state approved amount, not including utilities, internet or TV.  Our actual fees are therefore $600 for rent, $100 for utilities, $50 for TV/internet and $200 a month for food, which we include, totaling $950 a month.
Visions has tried to keep the cost of the residential fees to a level that individuals can pay using their social security income.  Visions has supplemented the actual cost which is higher than our residential fees.

We will be assisting residents to obtain Section 8 Housing Vouchers, which will be used to supplement the difference between our residential fees and our actual costs.
For individuals who are not eligible to obtain the vouchers, we will continue to supplement the cost of actual rent and board.

​Recent per individual charges and actual costs:
Recently Visions Has Charged
Approximate Actual Visions Cost
$700 including board and room
$950 including board and room
c
    $600 rent
    $100 utilities
    $50 TV/Internet
__​$200 Food__
    $950 Total
While Section 8 housing vouchers can only cover rent and owner-paid utilities, the additional revenue vouchers provide would bridge all or most of the gap between current charges and actual charges. 
​
We will not be increasing any Visions residential fees for those residents who cannot access other sources of funding, such as Section 8 housing vouchers.

2)  Sources of Funding

     a) Social Security Disability Benefits

Supplemental Security Income (“SSI”) is a federal income supplement program funded by general federal tax revenues (i.e. not Social Security taxes).[1]  SSI provides a cash benefit aimed at meeting basic needs for food, clothing, and shelter. To be eligible for SSI, a person must either be aged, have a disability, or be blind and must meet income and resources limits, which are quite low.  A person can be eligible for SSI from birth if these requirements are met. 
 
SSI provides monthly cash benefits up to a maximum benefit level known as the Federal Benefit Rate (“FBR”). The FBR represents both the SSI income limit and the maximum federal monthly SSI payment.  For 2019, the FBR increased 2.8% to $771 per month for individuals and $1,157 for couples. The FBR increases annually if there is a Social Security cost-of-living adjustment.  How much of the FBR an individual or couple is actually eligible to receive in a given month depends on a number of factors, including earnings and unearned income received from other sources. Because SSI supplements these other types of income, the more a person has in earnings and unearned income, the less they receive in SSI.  As a result, income support provided by SSI may vary from month to month as an individual’s or couple’s financial situation fluctuates.
 
There are two categories of SSI beneficiaries:
  • Supplemental Security Income benefits are paid to low-income recipients who are disabled, blind or elderly and have limited resources.
  • Child's Disability benefits are paid to children up to age 18 who are disabled or blind and whose families meet income and resources criteria.
 
Social Security Disability Insurance (“SSDI”) is a payroll tax-funded, federal insurance program.[2] SSDI provides supplemental income to people who are restricted in their ability to be employed because of a disability, usually a physical disability.  SSDI can be either temporary or permanent, depending on whether a person's disability is temporary or permanent.  The dollar amount of a person’s SSDI benefit is based in large part on their (or their qualifying spouse’s or parent’s) level of contributions to the Social Security Trust Fund:  how much the person earned and how long they worked. As a result, the amount of the monthly cash benefit varies significantly from person to person.  Once calculated, a person’s SSDI benefit is fixed and won’t fluctuate as a person’s SSI benefit can.  An SSDI beneficiary will either receive their full cash benefit in a given month or no income support at all. 
 
Because SSDI disability benefits are not based on economic need, resources are not considered and have no bearing on either eligibility or payment amount.  Earnings from a job or self-employment may affect eligibility since the benefit is designed for persons whose ability to work is impacted by a disability.  After a beneficiary has worked for a period of time, the SSA will determine whether or not they should continue receiving their benefit.[3]  Earned income and SSDI benefits are not absolutely mutually exclusive. There are a number of work incentives[4] in the program that make it possible for beneficiaries to work and to continue to receive their SSDI benefit.[5]
 
There are three categories of SSDI beneficiaries:
  • Disability Insurance benefits are paid to people who have worked long enough to earn sufficient credits under the Social Security system but are now disabled.
  • Disabled Widow's, Widower's or Surviving Divorced Spouse benefits are available to a person whose deceased spouse’s work history qualified for coverage.  The surviving spouse must be over age 50, must have a disability, and must meet some additional requirements.
  • Childhood Disability benefits are available to an individual who is at least eighteen years old, developed a disability prior to the age of twenty-two, and who has a parent who worked and either receives a Social Security benefit based on his or her work history, or who has died. The payment to the child is based on the earnings record of a qualified parent who is retired, disabled or deceased.
 
Both SSI and SSDI are administered by the federal Social Security Administration; both apply the same criteria in determining whether one has a qualifying disability.  The fundamental difference between SSI and SSDI eligibility is that SSDI benefits are available to workers (or in some cases the worker’s spouse or child) who have accumulated a sufficient number of work credits, while SSI benefits are available to low-income individuals who haven't earned enough work credits to qualify for SSDI.  Because of the SSDI work history requirement, persons with I/DD who qualify for federal disability benefits typically receive SSI rather than SSDI.  There is a five month waiting period after a beneficiary is determined to be disabled before the beneficiary begins to collect social security disability benefits.
 
Providers and guardians must be vigilant in anticipating where an individual may earn income, receive unearned income, or acquire assets which may render an individual under their care ineligible for benefits.  While the specifics of how the Social Security Administration calculates income and resources are beyond the scope of this Toolkit, the limits are low.  For example, as of 2019, an individual’s resources must amount to $2,000 or less for the individual to remain eligible for SSI.
Supplemental Security Income (SSI) Program Rates & Limits - 2019
Monthly Federal Payment Standard (dollars)​
b
      Individual
771
      Couple
1,157
Cost-of-Living Adjustment (percent)
​2.8
​Resource Limits (dollars)
c
      Individual​b
​2,000b
      Couple
3,000
​​Monthly Income Exclusions (dollars)
c
      Earned Income (a)
65
      Unearned Income
​20b
​Substantial Gainful Activity (SGA) Level for the Nonblind Disabled (dollars)​
1,220
(a) The earned income exclusion consists of the first $65 of monthly earnings, plus one-half of remaining earnings.

Next Expected Update to Rates and Limits:  October 2019. Subscribe to Updates
​Other Editions: 2018  2017  2016  2015  2014  2013  2012  2011  2010  2009  2008  2007  2006  2005
For historical program data, see the Program Provisions section of the Annual Statistical​.
​The SSI benefit for an individual, as of 2019, is $771 per month.  A provider may be receiving all, or almost all, of a served individual’s SSI benefit (through a guardian and/or payee).  Absent other income flows, a Supported Housing provider could be providing room, board, and covering the costs of personal incidentals, such as toothpaste and clothing, for $771 per month.  
View Footnotes
[1]  SSI benefits are an entitlement arising under Title XVI of the federal Social Security Act.
 
[2]  SSDI benefits are an entitlement arising under Title II of the Social Security Act.
 
[3] One of the measures the SSA uses in making this determination is Substantial Gainful Activity (“SGA”). The SSA reviews a person’s gross earnings over a period of time, applies certain deductions, and then decides if the remaining amount of countable earnings represents substantial work. A decision by SSA that a beneficiary’s work is “substantial” will result in a loss of their cash benefit. For 2019, the monthly SGA limit is $1,220 for non-blind SSDI or SSI applicants with a disability, and $2,040 for blind SSDI applicants (the SGA limit doesn't apply to blind SSI applicants).
 
[4] While beyond the scope of this Toolkit, SSDI work incentives include Impairment Related Work Expense offsets against income, Plan for Achieving Self-Support provisions (also available for SSI beneficiaries), and extended Medicare eligibility after cash benefits have stopped.
 
[5] The impact of earned income on SSDI can be phased in order to protect beneficiaries as they wean themselves off SSDI through resumed employment. In succeeding phases, protections allow for all or some of the monthly benefit to be retained while a beneficiary tests their ability to work.

     b) Other Family/Person-Served Contributions

​A supportive housing project must decide early in the development process whether or not to require residents or their families to contribute in excess of each resident’s public benefits.  As a national matter, family-driven supportive housing development is often being built on a buy-in model, in which future residents, or their families, contribute significant up-front capital.  There are also models in which rent exceeds what can be satisfied through public benefits.  While the numbers are all the more challenging without such family financial contributions, this Toolkit does not assume they will be available.  The Toolkit aims to provide a route forward for families whose resources may consist primarily of hope, commitment, and indomitable will.

The Visions Experience:
Keeping Our Housing Affordable by All

We made the decision not to require our residents or their families to “buy-in” with upfront investment.  We also committed to making it possible for an individual to live a full life relying only on their public benefits.  This does require a significant amount of fundraising.  The numbers become significantly less challenging for each individual who becomes eligible for a Section 8 housing subsidy.  Without the subsidy, all of the individual’s SSI must go towards rent and related costs.

     c) Other Rents or Income From Mixed Use

​One might consider possibility of operating an income-producing business, or renting out income-producing space, with the aim of financially supporting the housing setting.  In addition to the common risks inherent in operating any business, one would have to proceed especially cautiously, evaluating the risks of coming into conflict with requirements of Medicaid, state regulations and the underwriting requirements of funders.

     d) Section 8 Housing Subsidies For Individuals

Under the Federal Housing Choice Voucher Program (commonly known as “Section 8”), a qualified household pays a portion of their adjusted income towards rent and utilities, and New Hampshire Housing pays the remainder directly to the landlord.  The rental unit is selected by the renter and must meet certain housing quality standards.  The goal of the program is to provide safe, decent, sanitary and affordable housing to very low-income households.[1]
 
Section 8 in a nutshell:
  • Individual pays 30% of income in rent to landlord; the balance is paid to the landlord with funds from the US Dept. of Housing and Urban Development
  • Section 8 eligibility will not affect SSI or Medicaid benefit eligibility
  • The Section 8 waitlist is years long, but NH recipients of Waiver funds receive a preference allowing them to qualify for the subsidy more quickly.
  • A family member can be an eligible landlord for a Section 8 unit, as a matter of reasonable accommodation, but the unit in which the tenant resides must qualify as a separate, independent living space.

​Program eligibility is based on income. To be placed on the program, applicants must have incomes below 30% of the median income in the area they seek to live, which is usually going to be the case for a person with I/DD, if appropriate financial planning has been implemented. 
 
The wait for a voucher can be as long as a decade.  However, New Hampshire Housing gives  preference for Section 8 vouchers to persons receiving services through a Medicaid Waiver.[2]  In addition, a person with a disability may qualify for allocated vouchers under the Mainstream Housing Program.
View Footnotes
​[1] “The Authority will coordinate its program with other local housing authorities, other state agencies and local agencies to make the most effective use of the monies available. This will include working with special interest groups attending to the needs of individuals with disabilities, elderly, terminally ill and extremely and very low-income families. The Authority will also assist families with housing needs through its programs and referrals to housing related services.”  See Housing Choice Voucher Administrative Plan 2018, p. 15.
​
[2]  Individuals on the waitlist for Section 8 vouchers are subject to preferences weighted in the following order:
(a) Special purpose vouchers [Non-Elderly Disabled families (NED), HUD-Veterans Affairs Supportive Housing (VASH), or FUP] if the total number of special purpose vouchers which make up the voucher allocation have not been filled due to a funding shortfall.
(b) Project-Based Voucher holders who are victims of domestic violence, dating violence, sexual assault or stalking who are eligible for protections under VAWA.
(c) Project-Based Voucher holders.
(d) Veterans Affairs Supportive Housing (VASH) turnover vouchers.
(e) NHHFA will make available up to 50 vouchers for households impacted by major federally declared disasters designated by the Board of Directors who are Section 8 voucher holders or public housing residents in another jurisdiction. Once this need is met, households who are non-participants will be eligible for this preference.
(f) Participants whose rental assistance was terminated due to insufficient funds.
(g) The following will have equal weight: Terminally ill; CFI (Choices for Independence formerly known as HCBC) preference; DHHS Transitional Preference; Transitional Housing; family Break Up and Income Targeting.
(h) The following will have equal weight: Veterans as defined in 6.3.2 (g) and Rent Burdened/At Risk of Becoming Homeless.
(i) All others without a preference.
Housing Choice Voucher Administrative Plan 2018, pp. 45-46.

The Visions Experience:
§ 8 Individual Subsidies

At Visions, if we can get a § 8 subsidy for an individual, we get very close to covering the actual costs of housing that individual.  Accordingly, if all residents received § 8,  we would come close to covering real costs housing operations costs without having to allocate annual fundraising to covering operating costs.

In Enfield, we’re currently trying to get Section 8 funding for our residents.  To date, only one has been approved.  That individual’s subsidy is disbursed directly to Visions, as landlord.

A § 8 subsidy is calculated based on average housing costs in the local area and fluctuates with income.  In Enfield $600 per month (not including utilizes) is the average rent.  NHHFA can provide rent averages for your local area.

For § 8 purposes, New Hampshire imposes a cap of $661 on the amount one can charge for room and board (meaning rent, utilities, and client-consumable food). 

In Enfield, we round up to $700 to include the allocated cost of internet and cable.  Everyone pays that amount, through SSI or SSDI (everyone seems to get different amount) and often work income.  SSI tops out at around $700 but SSDI can exceed that.  The actual cost per individual is closer to $950 per month, but at Visions we are committed to keeping costs down for individuals so that no resident is in the position of relying on family contributions. 

​Some residents do have families who supplement the resident’s income, take them on trips, etc.  We want those residents who don’t have such family subsidies to have money for clothing and going out to eat, etc.

     e) Energy/utility Assistance Programs

The Visions Experience:
Energy Assistance

Any low income individual can get fuel assistance through New Hampshire’s counties, as long as they meet the income criteria.  At Visions, we applied for that assistance for a couple living off campus, but they were found not to meet the income requirements.

     f) Fundraising

The Visions Experience:
Sources of Operations Funding

For operations (aside from Medicaid-funded elements like direct care), SSI/SSDI are the prime sources of funding.  Visions never functions as rep payee for a resident, which is a best practice, although not required.  An area agency will charge $30 per month to perform the rep payee function, but in most cases someone in the individual’s family is the rep payee.  Best practice is to avoid having either the vendor or area agency act as rep payee, if possible.

Some families also make annual donations.  That is not a requirement for an individual to reside at Sunrise Farm, and not all residents have families in a position to contribute.  We also raise money from foundations and individuals.  We are in the process of encouraging our board of directors to be more on the fund raising side.

Funding for ongoing capital costs has come through the New Hampshire Community Loan Fund (loan for septic system) and NHHFA (grants for upgrades and a recently-closed mortgage which will permit major upgrades). 

​For those residents who receive housing subsidies, they fill the gap between SSI/SSDI and actual room and board costs which otherwise need to be covered through annual fundraising.

     g) Putting it all Together:  Practical Considerations in Financing Operations

The Visions Experience:
​Financing Operations

Be prepared:  it takes time for the State to process payments.  For example, you can expect to get reimbursed for October billables in mid-November.  When Visions first launched, Sylvia would put personal funds into its bank account to permit payroll to go out.  It’s essential to have $20,000 or $30,000 in your operating account as working capital to buffer delayed receivables.  For a small outfit like Visions, the delay is exacerbated because payment has to go through the area agency.  Providers will start getting paid directly by the State, but Visions is probably too small to make that practical for us.

To finance its day-to-day operations, Visions relies principally on three categories of income. 
  1. SSI.  Each resident receives monthly SSI payments from the federal government which goes to Visions to fund the resident’s room and board.  
  2. Medicaid.  As discussed more fully below (in “Funding Supportive Services”), Visions contracts with the local area agency, Pathways of the River Valley, to provide supportive services to residents.  Pathways serves as the pass-through for Medicaid dollars that fund certain care costs, such as the labor costs of employees providing direct care to residents.  Thus some operating costs of Visions, such as providing direct care, are funded by Medicaid.  Additionally, a percentage of direct-care Medicaid funding to cover its administrative overhead.  
  3. Grants and Fundraising.  Proceeds from SSI are insufficient to cover the full costs of room and board, and proceeds from Medicaid are insufficient to cover the full costs of direct care and administrative overhead.  Resulting budget shortfall is addressed through recurring grants and annual fundraising. Each of these categories of funding is essential for operating supported housing.  For example, in recent years a well-organized, well-financed and sophisticated group of families sought to develop a housing setting for I/DD family members but was unable to proceed because the local area agency was unable to guarantee that the setting would be eligible to receive Medicaid dollars.  (See the discussion of “Medicaid Home and Community Based Services Settings Requirements” in this Toolkit.)

​Finally, there is the fourth important category of operations funding:  Section 8 (and Section 811) vouchers (see discussion of these programs, above).  If the time were to come that residents were approved for that form of housing subsidy and those additional HUD dollars begin to flow to Visions, aggregate government funding would come closer to accounting for the actual costs of housing and supporting Visions’ residents.  Farmsteads of New England, whose residents in Hillsboro have vouchers, reports that SSI, Medicaid, and housing subsidy dollars, together, suffice to support each resident’s actual room, board and care costs.  

The Visions Experience:
Debt

Visions pays the mortgage on Sunrise Farm, making monthly payments of $4,000, as well as monthly payments on its vehicles.  
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