By Anne Montgomery
Around the country, people at more than 600 “watch parties” gathered to tune into a livestream of the White House Conference on Aging (WHCOA) [http://www.whitehouseconferenceonaging.gov] on Monday, July 13, 2015. Hosted by the White House in the East Wing and the Eisenhower Executive Office Building with an invited audience of about 200 attendees, the sixth WHCOA featured more than two dozen speakers, most notably President Obama. They heard about many accomplishments, a few shortcomings, and a commitment to taking forward some solutions—but not enough. Striking a tone that was both optimistic and pragmatic, the President observed that even as challenges for health care programs and for individual retirement security are “becoming more urgent” due to the sheer size of the Baby Boomer cohort, older adults are “living longer and living healthier. We’re seeing people break athletic records—in their 60s,” he noted with a smile.
Turning to policy, the President called on attendees, policymakers, and citizens to keep Medicare, Medicaid, the Older Americans Act (OAA), and Social Security robust and available, not only for current seniors but also for younger generations. “For Medicare,” he noted, “that means we’ve got to keep slowing the growth of health care costs.” While no blueprint was presented at the conference for how to accomplish this, the Obama Administration waded into these controversial waters last January with an announcement by U.S. Department of Health and Human Services (HHS) Secretary Sylvia Burwell that the agency would attempt to shift half of all fee-for-service Medicare payments by the end of 2018 to “alternative payment models.” These include a variety of shared savings initiatives, including Accountable Care Organizations as well as voluntary and perhaps even mandatory “bundled payment arrangements.” HHS recently announced that it would require a hip and knee replacement surgery bundle for all hospitals in 75 geographic areas [http://www.modernhealthcare.com/article/20150709/NEWS/150709916].
The President flagged other issue areas as important to an aging society, including nutrition assistance for older Americans living at home who need it. The Supplemental Nutrition Assistance Program (food stamps) will allow participants to purchase prepared food in the Meals on Wheels program for the first time.
The President also announced an update of “quality and safety regulations for thousands of nursing homes, the first major overhaul in nearly 25 years.” The proposed regulation [https://www.federalregister.gov/articles/2015/07/16/2015-17207/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities?utm_content=header&utm_medium=slideshow&utm_source=homepage] includes changes designed to improve resident quality of care and quality of life. One requires consultant pharmacists who conduct monthly drug regimen reviews to compare medication administration records with medical charts to determine whether antipsychotics or other psychotropic drugs and antibiotics that were administered actually correlate with diagnoses. Another specifies that facilities cannot hire individuals who have had disciplinary action taken against their professional license for abuse, neglect, mistreatment, or misappropriation of resident property. Nursing homes will have to provide training in dementia management and resident abuse prevention training to all nurse aides [http://www.cms-handinhandtoolkit.info/] and must promulgate clear standards for ongoing quality assurance and for establishing compliance and ethics programs designed to curb fraud. The regulation further proposes to require facilities to conduct thorough, competency-based assessments of staffing adequacy and training in order to make “thoughtful, informed staffing plans and decisions that are focused on meeting resident needs, including maintaining or improving resident function and quality of life.” When combined with adequate enforcement and the forthcoming requirements for mandatory reporting of staffing based on payroll data—which will include information on staffing levels, type of staff, tenure, and turnover—this requirement could provide far more accurate and comprehensive information about what arrangements work best for varying resident populations and how these correlate with the results of health and safety inspections and quality outcomes [http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html].
President Obama and other speakers called for the reauthorization of the OAA, which subsequently cleared the Senate on July 16 by unanimous consent [https://www.congress.gov/bill/114th-congress/senate-bill/192?q=%7B%22search%22%3A%5B%22%5C%22s192%5C%22%22%5D%7D.] The law expired in 2011 and has languished in Congress for 4 years, struggling to amass sufficient political support. In the House of Representatives, the OAA has not yet been marked up, which falls within the jurisdiction of the Education and Workforce Committee.
While it is encouraging that a reauthorization of the OAA is moving forward, the statute has not been retooled to meet the needs of millions more seniors in the 21st century, possibly because doing so might require allocation of more resources. By virtually any measures, the law is seriously underfunded to meet on-the-ground needs of elders who have both chronic conditions and functional limitations. For example, in a growing number of cities and regions around the country, access to home-delivered meals is nonexistent [http://www.mealsonwheelsamerica.org/theissue/facts-resources/more-than-a-meal]. In an era when tens of millions of aging boomers intend to age in place in their own homes and communities, the basic long-term social services and supports that they will need have gone missing—services like subsidized transportation, household management and personal care, assistance with nutrition and access to medical services, benefit programs, and other fundamentals of daily life.
During the national conference, no panel squarely addressed the glaring lack of a plan to address these gaps, though there was much discussion of this topic during the regional seminars and other events leading up to the WHCOA. This may be because there is as yet no political or policy consensus on how to proceed. Meanwhile, a recent research brief prepared by the HHS Assistant Secretary for Planning and Evaluation, “Long-Term Services and Supports for Older Americans: Risks and Financing,” stated that about half (52%) of Americans turning 65 today will develop a disability serious enough to require long-term services and supports (LTSS), with about one in seven adults needing assistance for more than 5 years. Americans turning 65 today will incur $138,000 in future LTSS costs, about half of which families will pay out of pocket [http://aspe.hhs.gov/daltcp/reports/2015/ElderLTCrb.cfm].
With the number of frail elderly Americans set to double over the next few decades, much more needs to be done to meet the needs of our aging population. Raise aging issues in the upcoming campaigns—ask the politicians for their thoughts, ideas and what concrete actions they would take if (re)elected. If you want to present specific ideas and join a gradually building movement, send friends and neighbors to the Family Caregiver Platform Project [http://caregivercorps.org], where they can find ways to take action and planks that they can suggest in local caucus meetings or in letters to state convention delegates. Push officials to raise funding for local services and to support elders in their communities in other ways. The time for congratulations and commemorations on past successes is nearly behind us; it is now time for new action!