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Saturday, August 18, 2018

Silver Tsunami Is Crashing Into Bay Area’s Housing Crisis


Seniors in the Bay Area already have limited options in a tight housing market, and for those in need of affordable housing, the situation borders on a crisis.
Eden Housing CEO Linda Mandolini has seen people line up at 4 a.m. just to get on a waiting list for housing. For a 150-unit property in Hayward, which included 50 senior housing units, Eden Housing received over 4,500 applications. Not enough age-restricted housing has been built in the last decade, leaving a huge opportunity for developers to tap into a market with high demand and high occupancy rates.
Affordable housing developers have struggled to keep up with demand from low-income seniors, with waiting lists up to 10 years long. Private developers that build market-rate senior housing are leasing up units faster than ever before.
“People don’t know where to go,” Mandolini said. “Seniors are getting priced out of apartments. They might not be living in optimal situations. Their kids aren’t super wealthy and don’t have enough room to accommodate their parents.”
As more baby boomers age, demand for senior housing has increased, but affordable senior housing is becoming even more difficult to find since most affordable housing funding sources target families and other vulnerable populations.
It is not just a California problem. The number of senior renters aged 60 needing rental assistance across the U.S. is expected to increase by 1.3 million through 2020, according to a Harvard study. Another 1.3 million will need rental assistance by 2030. At current assistance levels, roughly 3 million to 4 million seniors will be forced to look for housing in the private market by 2030.
While the average amount of retirement savings has risen since 1980, nearly half of all American families, including age groups nearing retirement have little to no retirement savings, according to a report from the Economic Policy Institute. West Coast baby boomers are currently at the highest risk to be homeless and 40 million could retire with little to no savings.
In California, which has among the highest costs of living in the country, the population of senior citizens is expected to increase 112% from 1990 to 2020. This demographic is expected to grow twice as fast as the state’s overall population, according to data from California Department of Aging.
San Francisco and San Mateo counties, two of the most expensive counties in the region, are expected to have the largest increase in people aged 60 and older.
“Affordability is hammering on seniors, especially those on fixed incomes,” Christian Church Homes President and CEO Don Stump said. “Social Security checks might go up 1% to 2% each year, but wages are going up much faster. Housing costs are doubling and tripling on a regular basis.”
Even though demand has been skyrocketing, building senior housing isn’t easy, especially since funding sources on both a state and federal level have vanished. When the HUD 202 federal program, which once provided $700M in funding, stopped funding new affordable senior housing in 2012, thousands of projects were stopped, Stump said.
The HUD 202 program gave capital grants to help offset operating costs and to help cover the cost of housing extremely low-income seniors, Mandolini said.
The end of redevelopment in California also hit affordable housing, Stump said. Redevelopment agencies were funded by property taxes and were used to redevelop blighted areas.
Resources for Community Development Executive Director Dan Sawislak said the affordable housing industry has lost a billion dollars a year since the end of redevelopment in 2011. Thousands of units of housing that could have been built were not, he said.
Part of the problem is Proposition 13, which capped property taxes at 1976 levels plus a 2% annual increase, Bay Area Council Senior Vice President of Public Policy Matt Regan said. The policy was meant to protect seniors and homeowners from increasing property taxes that they couldn’t afford, but ended up trapping seniors in their homes, he said. Seniors who sell their homes have to pay taxes on today’s property assessment during the transaction, which makes the sale expensive, he said.
“These are Prop 13 prisoners. Seniors are rattling around in large homes that they bought in the ’60s, ’70s and ’80s and can no longer afford to move,” Regan said. “In a normally functioning cycle, these houses would go back to younger families.”
Since 2010, production of senior housing has plummeted in San Francisco. Even though the production of affordable housing increased 83% in 2017 in San Francisco, only 3% of the housing produced was for seniors. Of the 1,466 units of affordable housing built in San Francisco during 2017, 76%, or 1,116 units, was for family housing, while 39 units were for seniors, according to a report from the San Francisco Planning Department. Comparatively, 12%, or 348 units, of 582 affordable housing units built in 2010 were devoted to seniors. About 1,170 units of affordable senior housing were under construction with another 1,547 in the planning stages during 2017, but this is out of 3,169 units of affordable housing under construction and over 9,000 affordable housing units in the pipeline.
It is not just the shortage of housing, but also demand for the right type of housing that exacerbates the problem. For-profit developers jumped into assisted living thinking that this category of senior housing would fill up quickly, flooding the East Bay with assisted living campuses, Stump said.
Many of these campuses ended up with high vacancies since seniors preferred independent living options, he said. Seniors are waiting later to move into a designated senior housing development.
Just because someone turns 55, doesn’t mean they suddenly want to live in a senior development, BRIDGE Housing CEO Cynthia Parker said.
“Most people are still active and want to stay active,” Parker said. Seniors also would rather not go into a nursing home. “If you put 50,000 Americans in a football stadium, they will not agree on anything,” Stump said. “But if you ask those 50,000 how many would like to live in a nursing home, no one will raise a hand.”
These seniors seeking to continue living independently have put a lot of demand on market-rate units. SRM Development built a 130-unit senior housing project in the Rockridge area of Oakland that was the first senior housing built in over 25 years in the neighborhood. Demand was so high, it leased up within six months, compared to an average of a year for senior housing.
Another element developers in the industry will have to keep in mind is that seniors that move into a senior housing complex end up being older and require more services. Stump said seniors aged 80 and older are the fastest-growing resident demographic of affordable senior housing. This has shifted how and in what way affordable housing developers offer services and where they build their projects.
Developers are finding ways to meet the growing needs of the Bay Area’s senior population. Unlike affordable housing for families that typically needs to be near transit and requires more parking, senior housing doesn’t have a high parking requirement and typically needs to be close to healthcare services, Mandolini said.
Eden Housing, which has been providing senior housing to extremely low-income seniors since 1972, offers enhanced affordable housing so residents can stay healthier for longer. This often means offering healthcare and supportive services. Many of its residents can’t afford assisted living and were priced out of that market.
“They move in with us and live with us for their rest of their lives,” Mandolini said.
An Eden property in Fremont, Cottonwood Place, partnered with On Lok, a Program for All-Inclusive Care for the Elderly, that allows residents to stay in their homes and age in place. PACE is a community-based healthcare model that typically offers in-home care and social services.
“The healthcare piece of this is super-important,” Mandolini said. “It costs so much more to put people in a nursing home than to opt them into something that keeps them independent. We should want to do more.”
Healthcare providers also are looking into ways to provide more senior housing as part of a larger community. Pacific Medical Buildings and Generations LLC are planning to build 800K SF of housing, office and community space in Burlingame. The developers plan to partner with Peninsula Health Care District to create a senior community with up to 375 units of housing, including independent and assisted living, 100K SF of support services, 250K SF of medical office and a 50K SF center with dining, and nonprofit and community programming, according to the San Francisco Business Times.
Christian Church Homes, which has 5,000 senior residents living in 61 properties across nine states, works with faith-based organizations as part of its business model. Groups will donate or sell the land at a steep discount so that CCH can build affordable senior housing, Stump said. CCH is currently working with three Bay Area churches to secure additional parcels.
BRIDGE Housing, which has built over 4,000 senior housing units, has been creating more intergenerational housing that has senior living as well as housing for young families. Seniors often feel energized by having young kids around and multigenerational families can live close together, Parker said. BRIDGE Housing is planning to build senior housing at 735 Davis in San Francisco that would be part of a two-building complex that would include family housing. Another 85 units are underway next to 115 units of affordable family housing near the San Leandro BART station.
A private developer is working on a luxury senior housing complex in San Jose. Alliance Residential Co. recently began construction of a 204K SF private fully licensed Residential Care Facility for the Elderly. It will have luxury amenities and 24-hour staff to provide a variety of  medical and day-to-day needs for residents. The four-story building, built by Swenson, at 4610 Almaden Expressway will have 200 units, a mix of 30 memory care units and 170 independent living units.
Bay Area Council’s Matt Regan said one of the best solutions to creating more senior housing stock would be to make it easier for homeowners to build accessory dwelling units, which are smaller secondary homes built on the same lot.
“Sooner rather than later, we’ll have ADU saturation somewhat similar to Vancouver, where a third of homes have an ADU,” Regan said. “It is the single biggest supply of affordable housing.”
If 10% of the Bay Area’s million and a half homes added ADUs, that would create 150,000 new homes, Regan said.
“We think this will be very beneficial to seniors,” he said.
Even with developers and policy groups working to build individual senior housing projects, demand will only get worse, especially as all demographics and income groups struggle to find adequate housing. Low-income for individuals is now $82K in San Francisco, the highest individual low income in the country, Curbed SF reports. One in five households can afford a median-priced home in the Bay Area.
“The need is going to get bigger. For sure we have a crisis,” BRIDGE Housing’s Parker said. “The crisis is being caused by more people moving into the Bay Area making good money and driving up prices. Seniors are being squeezed … just like everyone else.”
Christian Church Homes’ Stump said the largest-growing segment of the homeless population is homeless seniors and many seniors will be forced into situations where they will have to live in a basement or share a one-bedroom apartment. He has hope despite the dire need for more housing. Local municipalities have already passed bond measures that could help replace money lost in recent years and additional bond measures to help fund more affordable housing are on the November ballot, he said. While replenishing funding sources and pushing forward with ADUs will help, Eden Housing’s Mandolini said it comes down to adding more supply.
“We need to build more,” Mandolini said. “We have to get this stuff approved.”

Healthcare sharing ministries offer another insurance alternative


While there’s been a lot of attention paid lately to association and short-term health plans, there’s another option that’s largely flown under the radar. Healthcare sharing ministries are exactly what they sound like; plans that gather the resources of a group of people with common religious beliefs. And they’ve been growing at a rapid pace. The plans are estimated to cover nearly 1 million people across the country. Just three years ago, that number was at 160,000. Here are some more useful numbers to consider when trying to understand healthcare sharing ministries. Download the PDF.

healthcare sharing ministries

Apollo Hospitals AI-powered platform to predict risk of cardio-vascular disease


Indian healthcare major Apollo Hospitals and UT giant Microsoft have jointly developed an AI-powered platform that will predict cardio-vascular disease (CVD) risk in the Indian population. Launched on Friday, the AI-powered Cardiovascular Disease Risk Score API (application program interface) can be used by doctors across the Apollo network of hospitals to predict risk of CVD and drive preventive cardiac care across the country. The collaboration between the two companies is part of Microsoft’s AI Network for Healthcare initiative.
However, the firms are not stopping at developing a system specific to the Indian demographic, but are also engaging global consortium partners to calibrate and scale this intelligent system for other population groups, the statement from the firms said. Built on Microsoft Azure, the said API aims to determine a more accurate CVD risk score for the Indian population. According to the firms, the API has been developed using a combination of applied AI and clinical expertise on a large sample of retrospective data on health checks and coronary events.
“The scoring considers risk contributors including lifestyle attributes like diet, tobacco and smoking preferences, physical activity as well as psychological stress and anxiety as reflected via rate of respiration, hypertension and systolic and diastolic blood pressure,” the statement said. The score categorises risk into high, moderate and minimal and using the insights, physicians can make timely intervention and help patients with the lifestyle modifications needed.
“This partnership is part of our continuing endeavour to design new tools and equip our doctors in the fight against non-communicable diseases. The amalgamation of AI and machine learning with the global expertise of our doctors will help prevent heart disease, save lives and ensure those with heart disease can make informed choices on their health,” Apollo Hospitals Joint Managing Director Sangita Reddy said.

Medtronic testing defibrillator that uses wires outside the heart, veins


Traditional implanted pacemakers and defibrillators use thin wires called “leads” to send out electricity that keeps the heart beating properly, but these wires can also be associated with problems, from dislodgements and equipment failures to valve damage and infections.
Medtronic, which already sells a tiny pacemaker without leads, has begun early human testing of a new defibrillator it developed in Minnesota that can deliver high-voltage shocks to restart the heart or re-establish normal rhythm without needing wires that physically touch the heart or blood vessels.
The device “has the potential to deliver the benefits of traditional ICDs while eliminating the risks that can occur when leads are implanted inside the veins and heart,” like dislodgements and lead fractures, said Dr. Ian Crozier, the New Zealand doctor who is serving as principal investigator for the clinical trial of the Medtronic device.
Avoiding leads to cut down on complications is not a new concept. Since 2012, Boston Scientific has been selling a device called the Emblem S-ICD, which is a defibrillator that sits just below the skin, usually under the armpit. The Emblem system, developed in California, delivers current to the heart using a lead that is also just below the skin but above the rib cage, so it doesn’t enter blood vessels or the heart.
The MRI-approved Emblem has been a strong growth driver in Boston Scientific’s heart division, and CEO Mike Mahoney recently reminded investors that the company has “a multiyear head start” over any competition in the category (Boston Scientific acquired the Emblem’s inventor, Cameron Health, in 2012.)
But Medtronic has been testing and publishing data on what it calls its EV ICD system for years, and last week it announced the first in-human implant for a patient who intends to use the device long-term as part of a clinical study. Medtronic’s pilot study will enroll 20 patients at hospitals in Australia and New Zealand and check the patients regularly for safety and device performance.
The Medtronic device is the same size and shape of its traditional ICDs and is being designed to have a similar 10-year battery life. The device is implanted under the skin below the left armpit, and the lead runs underneath the breastbone — instead of above the bone — without entering the heart or blood vessels.
Mike Marinaro, general manager of Medtronic’s cardiac rhythm and heart failure division, said in a company announcement, “this pilot study is a significant step forward in our EV ICD clinical development program, as we aim to offer patients the therapies of a traditional transvenous ICD, but without leads implanted in the heart.”
(“Transvenous” refers to a lead that goes inside a blood vessel, and “EV ICD” is an abbreviation for “Extravascular Implantable Cardioverter Defibrillator.” The “S” in S-ICD stands for “subcutaneous,” which means under the skin.)
There are some differences between Boston Scientific’s S-ICD and Medtronic’s EV ICD.
The Medtronic device in clinical trials is capable of delivering both high-voltage shocks to restart a heart and low-voltage pacing therapy to treat a slow heart beat. Boston Scientific’s device can defibrillate, but it’s not suitable for long-term pacing. Medtronic’s device can deliver “anti-tachycardia” pacing to stop a racing heart beat, which may avoid the need for defibrillation and preserve battery.
Dr. Ken Stein, chief medical officer for Boston Scientific’s heart-rhythm device division, said pacing functions are not being added to future generations of the S-ICD. Instead, the company is designing its new capsule-sized leadless pacemaker called the Empower to communicate with the S-ICD to provide that function in patients who need a defibrillator and pacemaker. The Empower is not currently available for sale, but it is expected to enter a pivotal U.S. clinical trial later this year, Stein said.
There may also be differences in infection risk, voltages need to defibrillate, and battery life, but those remain to be proven out in clinical trials.
Asked when the EV ICD device might be available on the U.S. market, a Medtronic spokeswoman wrote, “Our path to approval will require a pivotal clinical trial. We aren’t able to share information about the (FDA approval) timeline, which will be informed by the pilot study as we plan the design, locations, etc., for the pivotal trial.”

Mateon Therapeutics Receives Notice of Partial Clinical Hold for Study


Mateon Therapeutics, Inc. (OTCQB:MATN), a biopharmaceutical company developing investigational drugs for the treatment of orphan oncology indications, today announced that the U.S. Food and Drug Administration (FDA) placed a partial clinical hold on Study OX1222 during a telephone conversation held with the Company on August 16, 2018. OX1222 is the Companys clinical trial of OXi4503 in combination with cytarabine for the treatment of relapsed/refractory acute myeloid leukemia and myelodysplastic syndromes. The partial clinical hold applies to the 12.2 mg/m2 dose of OXi4503. The FDA is allowing the study to continue to treat and enroll patients using a dose of 9.76 mg/m2 of OXi4503, which the Company previously tested in cohort 5 of Study OX1222.
The partial clinical hold follows two potential dose-limiting toxicities (DLTs) observed at the 12.2 mg/m2 dose level that was being evaluated in cohort 6 of Study OX1222. These DLTs consist of one patient experiencing hypotension shortly following initial treatment with OXi4503, and another patient experiencing acute hypoxic respiratory failure approximately two weeks after receiving OXi4503 and cytarabine. Both events were deemed possibly-related to OXi4503, and both patients recovered following treatment. The protocol for Study OX1222 generally defines a DLT as any grade 3 serious adverse event (SAE) where a relationship to OXi4503 cannot be ruled out. The FDA has indicated that additional data on patients receiving 9.76 mg/m2 of OXi4503 must be evaluated before the Company resumes dosing at 12.2 mg/m2.
Although it is disappointing that we are not currently continuing with the higher dose of OXi4503, we look forward to gathering more safety and efficacy data at the previous dose level, where we observed two complete remissions in the four patients that we treated, said William D. Schwieterman, M.D., Chief Executive Officer of Mateon.

Bayer rejects media report of fresh Dicamba lawsuits


Bayer AG on Friday rejected a report by German magazine WirtschaftsWoche, which claimed that farmers in the US had filed class-action lawsuits related to the Monsanto-produced Dicamba herbicide, according to a report by Dow Jones Newswires made available to EFE.
The WirtschaftsWoche article, which was published Thursday, alleged that farmers in Arkansas and South Dakota had filed new lawsuits against Monsanto in a US district court in St Louis.
However, Bayer said the report was incorrect as the lawsuits cited have been pending for weeks or months and aren’t directed solely at Monsanto.
“They have been known about for quite some time, and media from the United Statesand Germany have already reported on this matter,” Bayer said in a statement.
The article was one of several factors that dragged down Bayer’s share price on Thursday, deepening losses suffered on Monday after a California court ruled that Monsanto’s popular Roundup and Ranger Pro products presented a “substantial danger” to consumers.
Shares in Bayer listed on the Frankfurt Stock Exchange are down more than 15 percent this week, according to FactSet.
Bayer said it is aware of 37 separate suits with 181 plaintiffs filed in the US in connection with Dicamba.
Monsanto and other defendants have refuted the allegations, Bayer said.

CytoDyn ‘One to Watch’?


  • PRO 140 is a leading monoclonal antibody/viral-entry inhibitor therapy under development for two different Human Immunodeficiency Virus (HIV) indications and is also being pursued for multiple opportunities in other immunologic indications such as autoimmune disease, chronic inflammation, certain cancers, and transplant rejection
  • During 2017, 1.8 million people became newly infected with HIV, bringing the global total to 36.9 million people living with HIV (World Health Organization)
  • Market potential for PRO 140 used as an anti-viral agent in combination with HAART is $1.2 billion; as a monotherapy maintenance/single-drug therapy the market is estimated at $3.8 billion
CytoDyn Inc. (OTCQB: CYDY) is a biotechnology company focused on the clinical development and potential commercialization of a new class of HIV/AIDS therapeutics or viral-entry inhibitors intended to protect healthy cells from viral infection. The company’s pipeline includes its lead product, PRO 140 for multiple indications among which are human immunodeficiency virus (HIV), graft-versus-host disease (GvHD), colon cancer, and multiple sclerosis (MS), each in various stages of development. CytoDyn’s first approval is focused on HIV indications for two different HIV populations.
PRO 140 is a humanized monoclonal antibody directed at CCR5, a molecular portal that HIV uses to enter T-cells. PRO 140 works by blocking the predominant HIV (R5) subtype entry into T-cells by masking this required co-receptor, CCR5.
CytoDyn has completed one pivotal phase 3 clinical trials of PRO 140 use in combination with current drugs for population that has limited treatment options. PRO 140 is also currently in another phase 3 (investigative trial) for a second approval for another HIV population. HIV continues to be a major global public health issue. There is no cure for the disease that has claimed more than 35 million lives to date, according to the World Health Organization (“WHO”). In 2017, 940,000 people around the world died from HIV-related causes. There were approximately 36.9 million people living with HIV at the end of 2017 with 1.8 million people becoming newly infected during that same year. The WHO estimates there were 21.7 million people globally receiving antiretroviral therapy (“ART”) in 2017.
HIV targets the immune system and weakens the body’s defense systems against infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient which results in increased susceptibility to a wide range of infections, cancers and other diseases that people with healthy immune systems can fight off. The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from 2 to 15 years to develop depending on the individual.
PRO 140 functions by blocking the HIV co-receptor CCR5, a molecular portal HIV uses to enter T-cells, thus preventing the HIV virus from entering the cell. CCR5 is a protein located on the surface of white blood cells that normally serves as a receptor for chemicals that attract immune cells to the site of inflammation. Clinical trials to date indicate PRO 140 does not interfere with these normal CCR5 functions. Results from phase 1 and phase 2 human clinical trials have shown PRO 140 significantly reduces viral burden in people infected with HIV. Importantly, in a recent phase 2b clinical trial, PRO 140 demonstrated it can allow a subset of R5 strain of HIV population to replace their current HIV regimen (Highly Active Antiretroviral Therapy or “HAART.”) by a simple sub-cutaneous self-injectable dose of PRO 140 which is administered once a week. Some of those patients have received PRO 140 as their only therapy for almost four years.
The PRO 140 antibody appears to be a powerful antiviral agent with hardly any side effects, toxicity. More than 500 patients have used PRO 140 in clinical trial and no resistance has ever been developed in any patients including patients in monotherapy of PRO 140 for almost four years.
PRO 140, which is taken as an easy-to-use, weekly, subcutaneous self-administered dose, has almost no side effects or toxicity with no report of any serious adverse event related to PRO 140 in more than 500 patients in eight different clinical trial.
As we indicated earlier patients given PRO 140 showed no drug resistance on monotherapy for some almost four years while 76% of HAART patients developed a resistance to some portion of the lifetime drug regimen. Patient compliance with HAART is also the main reason why only 35% of HIV patients in US reporting complete viral load (VL) suppression which is VL<50 cp/mL.
In addition to its research into the powerful potential of PRO 140 for use in HIV patients, CytoDyn is pursuing PRO 140 as a therapeutic anti-viral agent in other non-HIV indications that could benefit from PRO 140’s ability to block CCR5. These immunologic indications include new reactions to cancer, transplantation rejection, autoimmune diseases and chronic inflammation such as Multiple Sclerosis. The company sees the significant potential for multiple pipeline opportunities for PRO 140.
The U.S. Food and Drug Administration has designated PRO 140 as a “fast track” product for HIV and granted Orphan Drug Designation to it for the prevention of GvHD in transplant patients. CytoDyn has initiated its first clinical trial with PRO 140 in an immunological indication for GvHD in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) who are undergoing bone marrow stem cell transplantation. The company is also investigating PRO 140 in animal models of cancer progression and autoimmunity with positive results and has published its animal study results in GvHD in peer-reviewed journal.
CytoDyn president and CEO Nader Z. Pourhassan, Ph.D. joined the company in 2008 and is credited for purchasing PRO 140 from Progenics in 2012 and has taken a new path to approval for the product. He is the co-inventor of monotherapy path for PRO 140. He has taken PRO 140 development from phase 2 to Completed successful phase 3 in about four years. He now has more than 10 years of drug development experience and has overseen the rapid clinical development of PRO 140 as a therapy for HIV into two phase 3 for two different indications. He also initiated PRO 140 first immunological indication in GvHD (currently in phase 2). He is also involved in preclinical and clinical development of PRO 140 in additional immunological indications. Dr. Pourhassan, who has more than 20 years of business development experience, has led CytoDyn’s capital market activities since joining the company in 2008. He received his Bachelor of Science from Utah State University, Master of Science from Brigham Young University, and his Ph.D. in Mechanical Engineering from the University of Utah and is the author of three books.
For more information, visit the company’s website at www.CytoDyn.com