Talking Heads, Sharon Wilson Géno, Executive Vice President and CEO, Volunteers of America National Services
By Darryl Hicks
14 min read
Volunteers of America, headquartered in Alexandria, VA, has dedicated itself to improving the lives of America’s most susceptible citizens: veterans, low-income seniors, children and families, the homeless, those with intellectual disabilities, those recovering from addiction and the formerly incarcerated. It ranks among the largest charities in the U.S. with total annual revenues of approximately $1.2 billion. It was founded in 1896 by social reformers Ballington and Maud Booth, who were the son and daughter-in-law of General William Booth, founder of The Salvation Army. Volunteers of America National Services, a subsidiary of Volunteers of America, is one of the largest nonprofit affordable housing developers in the country and also operates senior health care facilities.
VOA National Services started developing affordable housing over 50 years ago and over time has revolutionized the delivery of supportive services to the people it serves.
Sharon Wilson Géno—a well-respected lawyer with over 25 years of experience advising affordable housing professionals—joined VOA in 2015 as senior vice president of legal affairs. On September 11, 2017, she was promoted to executive vice president and chief operating officer of VOA National Services where she oversees an organization that operates senior living and care communities in nine states, as well as senior, multifamily and special needs housing properties in 42 states from Alaska to Puerto Rico.
Tax Credit Advisor sat down with Wilson Géno to learn more about VOA’s programs, how they are delivered and paid for, and how they are enhancing residents’ lives.
Tax Credit Advisor: Let’s start with what is the mission of VOA? And who are the communities you serve?
Sharon Wilson Géno: VOA is a ministry of service. The whole theme of the organization is how can we best serve America’s most vulnerable populations. In addition to the affordable housing and senior healthcare work we do at Volunteers of America National Services across the country, we have 31 local affiliates that deliver various services within a geographic region based on the specific needs of that community.
TCA: How large is your affordable housing portfolio? Which geographic areas are you most active? What percentage of your tenants are seniors, families and veterans?
Géno: The total number of units nationwide is about 20,000. About 69 percent of the affordable units are for seniors, 22 percent are for families and the remaining nine percent are for people with special needs, including mentally disabled residents who live in HUD Section 811 housing and veterans. We are in 42 states right now, but the key markets where we are particularly interested in expanding are Denver, CO; Dallas and Houston, TX; Minneapolis/St. Paul and Rochester, MN; Greater Miami, Tampa/St. Petersburg, FL; Sacramento, CA and surrounding areas. We also offer 46 healthcare programs unrelated to housing that include a wide constellation of services, such as skilled nursing, assisted living, PACE (Program for All-Inclusive Care for the Elderly), geriatric psychiatric services, transitional care, continuing care retirement communities, adult day care and senior meals programs.
TCA: Tell us about the ministry that is the guiding force behind your organization. Is it affiliated with a particular denomination? How does it influence your development activities and the services provided through VOA?
Géno: VOA is a non-denominational church, a church without walls. It is a very inclusive church that welcomes people from every walk of life—every race, culture, faith denomination, gender and sexual orientation—who are brought together by a common interest of fulfilling this idea of a ministry of service. In fact, one of the founding premises of VOA was that men and women would be treated equally within the organization. While the faith-based aspect is an important piece of the work we do, church memberships is a pre-requisite for being an employee here. What I find interesting about the ministry is that it infuses a true sense of purpose in the work and pushes us in places where other people don’t go. We are a 120-year old organization whose tradition has been to go where the need is greatest and look for opportunities to serve people who are most overlooked. For example, our founders were initially focused on the idea of prison ministry and working to rehabilitate people in the prison system in the 1890s, a very radical concept at the time.
TCA: When did the organization start developing affordable housing?
Géno: It was sometime in the 1960s that VOA started participating in HUD’s 202 program, which helped expand the supply of affordable housing with supportive services for the elderly. VOA was also involved early in the HUD 811 program for people with disabilities. Over time, we have become one of the largest, if not the largest, participants in both programs.
TCA: VOA’s organizational structure differs from most affordable housing developers in that it operates state and local affiliates that report to a national organization. What role do they play?
Géno: While VOA National Services is the affordable housing and senior healthcare arm of VOA nationwide, VOA also has 31 affiliates in different geographies across the country that provide a huge array of social services, such as reentry centers for state and federal correctional systems, behavior health, foster care and drug addiction and treatment. One affiliate provides treatment for opioid-addicted mothers. You name it, we are probably offering that service somewhere. A number of years ago, we shifted responsibility for managing our affordable housing properties to the affiliates. Not every affiliate chose to do that. It mainly depended on their location and mission. The affiliates also provide necessary services for the properties. A few of our local affiliates also have developed and managed affordable housing properties on their own, outside of VOA National Services. As you can see, our structure is flexible enough that we can create a wide-variety of partnerships depending on the circumstance. For example, we operate veterans housing programs in the Chicago area and our affiliate there both manages the property and the service component, and it was a co-developer with us. Sometimes we act as a technical assistance provider and they develop the housing. Sometimes when they are the developer, VOA National Services is a financial contributor to the deal, in other words we act as a lender or we provide guaranties.
TCA: How are the affiliates structured? Are they only located in areas where you operate affordable housing? Do they operate independently with their own management teams and annual budgets, or does headquarters dictate policies and what services are provided?
Géno: We are a federated organization which means that our affiliates are independently operated, but work under the VOA umbrella. Each local affiliate is incorporated in the state where it is headquartered, has its own local boards of directors, management team, budget, audit and other infrastructure. The national organization grants the affiliate a charter to use the VOA name and other resources and operate in a specific region, so long as the affiliate abides by certain policies. The local independence allows the affiliate to identify programs that are most needed in its area and pursue those, so long as they are consistent with the mission of the organization and its charitable purpose. This is a real strength of the organization – the ability to adapt programing to local circumstances while, at the same time, having access to the expertise and resources of a large, national organization.
TCA: VOA offers an amazing array of services for your older tenants, including adult daycare, home health services and memory support. How do your older tenants access these services? Do Medicaid waivers help pay for these services, or do you have other funding sources? Do tenants have any out-of-pocket costs?
Géno: Many of our healthcare programs are paid for under Medicare and Medicaid, including the Medicaid waiver programs in various states which supports assisted living, among other programs. In three states, we offer PACE services, which provides comprehensive medical and social services to frail, elderly individuals, who are dually eligible for Medicare and Medicaid benefits. Where the state supports it sufficiently, PACE is a great compliment to senior affordable housing, as PACE participants live in their own homes with services provided by the PACE provider unless, or until, they need skilled care. Participation in our other programs depends on the property and the type of service provided. Some of our residents are private-pay clients, who pay for services out of pocket. If I want to have my father enter into one of our skilled nursing facilities in Minnesota, I go and apply and see if he qualifies and access services that way. We are a player in the senior healthcare market like any provider. We also have relationships with many hospitals that refer clients to us.
TCA: Do you have on-site service coordinators at your senior housing properties, so that someone is available 24/7 when tenants need help?
Géno: We have service coordinators at almost every one of our properties. They tend to be social workers, not skilled nurses. They coordinate services paid for under the Older Americans Act, such as meals, healthcare, transportation and other things. We are participating in a HUD-funded demonstration program to put wellness nurses in our HUD-assisted affordable housing, who we call enhanced service coordinators. It’s a well-structured, five-year test program to show the impact of having that additional service in our buildings. We believe strongly that this works based on our past experience. We are looking for additional funding to put preventative health nurses in as many of our buildings as we can, because we think this can have a huge impact on healthcare costs, peace of mind for families and quality of life for residents.
TCA: What additional services do you offer to your younger tenants that distinguishes you from other affordable housing developers? And who is the organizer of those services at your affordable housing facilities?
Géno: We identify specific needs in a community and try to address them. At our veterans housing, we provide health services, substance abuse and addiction treatment and parenting support. At our family properties, it’s very situational. We have one property with a large Somali population where we offer after school programs and English classes. In most cases, our affiliate organizes these special services to the extent they are qualified to do so. In Colorado, we have some properties for people who are mentally ill. Our affiliate provides services to that community and it helps leverage other services, such as dental care, through a third-party. If there’s a service that’s needed which we don’t provide, we try to leverage other organizations that can make that available.
TCA: Can we look at a couple of examples of people or families who lived in your residences, took advantage of the services you provide and how it improved their lives?
Géno: The best part of my new position is being able to meet our clients and staff across the country and hear first hand how the work we do has transformed lives. It is truly inspirational. Here are just a few of the rewards of this job:
“Tammy” is a 55-year old woman who has a mental capacity of a nine-year old. For most of her life, she lived with her mother, a single parent, in the Washington, DC suburb of Arlington, VA. While Tammy was able to go to school for some of her life, her mother was only able to work part-time so she could care for Tammy. Money was always tight. Eventually, her mother was diagnosed with cancer and became very sick. Tammy was unable to care for her mother, or herself. When her mother was admitted to the hospital and it was clear she was nearing the end of her life, social workers from Arlington County contacted the VOA National Services team at the Mary Marshall Residence, a very special property that serves low-income adults with mental disabilities in an independent living environment. Mary Marshall was a formerly shuttered nursing home that was converted for this purpose by VOA National Services under the HUD 202 Assisted Living Conversion Grant, along with other federal and local sources. Tammy, who had never lived by herself before, was nervous at first, but she eventually became comfortable at her new home at Mary Marshall. She receives healthy meals in the dining room, participates in social events and outings, and has made new friends.
“Martha” is a military veteran who was one of the first women to serve on an aircraft carrier where she was stationed during 9/11. She suffered a sexual assault during her time in the military resulting in PTSD which made it hard for her to keep a job. Eventually, she and her two young sons wound up homeless. She was able to get help through a referral to Blue Butterfly Village – a 73-unit apartment complex developed by VOA National Services in partnership with VOA Los Angeles which is specifically designed to serve the needs of female veterans and their families. The property is located on a former military base and subsidized with Low Income Housing Tax Credits, project-based Section 8 and a variety of other sources. In addition to providing furnished units and recreational facilities, living there comes with on-site mental health counseling, job training, money management programs and childcare services. The goal of the program is to get vets back on their feet, but they can stay in these units for as long as they desire.
TCA: What services do you feel are most needed and make the biggest difference in residents’ lives?
Géno: Especially for senior residents it’s preventative healthcare. If we look at the big three – blood pressure, diabetes and COPD (chronic obstructive pulmonary disease) – having someone who’s helping our seniors and monitoring their progress on an ongoing basis has a huge impact on quality of life, hospitalization visits and healthcare costs. At our veterans’ communities having social workers, but also fellow veterans, assisting with services is vitally important to helping residents integrate back into society after having served our country.
TCA: How has the Affordable Care Act influenced the social services provided by VOA?
Géno: Are we talking about the Affordable Care Act before or after the individual mandate was eliminated (laughing)? All kidding aside, because we are funded through Medicare and Medicaid the impact will be less directly impactful for us. The greatest impact will be with our biggest referral sources, which are hospital systems. With the removal of the mandate, the idea of cutting hospitalization visits, especially for low-income, uninsured individuals, becomes even more important to them financially. The fact that we offer housing and healthcare services provides prime opportunities to do preventative work for older residents who may have been visiting hospitals more than they needed to, which ultimately helps reduce healthcare costs. It was because of the Affordable Care Act that people finally recognized the financial incentives on the healthcare side that result by combining or coordinating housing and healthcare.
TCA: Healthcare advocates are concerned that without an individual mandate insurance premiums will dramatically increase for everyone. Are you just as troubled? Are there steps VOA is contemplating to lessen the potential impact?
Géno: It’s not just insurance premiums that could be impacted, but also the services that will be covered. Our affiliates do a lot of important work in the mental health and behavioral health area. To the extent that mental health/behavioral health patients are not covered, or the amount and type of service levels are reduced, that’s a concern for us. In addition, VOA National Services operates a big healthcare system with over 3,300 employees across the country who are doing important work, but are not compensated at high levels. To be able to continue providing care to our seniors, it is very important for us to be able to provide healthcare coverage to our staff. If healthcare costs start going up, then we’ll need to address it. Given that Medicare and Medicaid reimbursement rates are not keeping up with the cost of living in many places, ensuring we can offer adequate health care insurance to our team is becoming a real challenge and something I am very focused on right now.
Story Contact:
Sharon Wilson Géno
swilsongeno@voa.org
