Public Policy & Aging E-Newsletter

Volume 2, Number 4, July 2008

This bimonthly e-newsletter highlights key developments and viewpoints in the field of aging policy from a wide variety of sources, including articles and reports circulating in the media, academy, think tanks, private sector, government and nonprofit organizations.

The goal of this email publication is to reach teachers, students, and citizens interested in aging-related issues, especially those who may not have sufficient access to policy information disseminated both in Washington and around the country.

I. WHAT’S HAPPENING IN WASHINGTON?

A. CMS To Rate Nursing Home Quality: The Centers for Medicare & Medicaid Services (CMS) announced it will soon launch a ground-breaking "five-star" ranking system of America's nursing homes. The ratings will be posted on the agency's Nursing Home Compare Web site by the end of this year. (A sample screen shot of the proposed star ratings is available here). CMS is requesting comments on the system designed to provide patients and their families an easy to understand assessment of nursing home quality, making meaningful distinctions between high performing and low performing homes.

B. Leading By Example: The Senate Aging Committee recently held a hearing to discuss how the nation's largest employer-the federal government-might serve as a role model for hiring and retaining older workers. The Government Accountability Office (GAO) presented testimony that examined (1) the age and retirement eligibility trends of the current federal workforce; (2) the strategies federal agencies are using to recruit, hire, and retain older workers; and (3) their observations on how these strategies position federal agencies to engage and retain older workers.

C. Safety of Seniors Act: President Bush recently signed legislation aimed at preventing falls among older adults. Under the Act, the U.S. Department of Health & Human Services (HHS) will develop education strategies to raise awareness about elder falls, encourage research to identify at-risk populations and evaluate falls interventions, and support demonstration projects. The Falls Free Coalition and other advocates are now calling on Congress to provide $20.7 million funding in FY 2009.

II. WHAT’S HAPPENING AROUND THE COUNTRY?

A. State Handbook of Economic, Demographic, and Fiscal Indicators 2008: Up-to-date state-level data on population, poverty rates, per capita state personal income, state tax rates, property tax relief programs, and state and local government revenues and spending programs are provided in this new edition of AARP Public Policy Institute's easy-to-use, biennial reference book.

B. Perspectives on State Health Reform: This essay from Kaiser Family Foundation President and CEO Drew Altman discusses the critical factors that influence state health reform efforts. Questions examined include: What lessons can be drawn from the Massachusetts health coverage law and California's failed health reform effort? And, if comprehensive federal health reform legislation fails in 2009, what can be done to spur more state-based health reform efforts?

C. The Administration on Aging (AoA) Nursing Home Diversion Program: This report from the National Senior Citizens Law Center describes the national aging services network's Nursing Home Diversion Modernization Grant Program-a demonstration project currently underway in 12 states-associated with AoA's new mandate to expand community-based long-term care options.

III. THIS ISSUE'S MAJOR POLICY STORY: HEALTH CARE REFORM

One of the remarkable things about the issues being highlighted thus far in this presidential campaign is how little attention has been focused on the contours of "societal aging." As was true in the past, the concept seems almost exclusively associated with "senior citizens." Why do we ignore the extent to which citizens with congenital defects or afflicted with debilitating chronic illnesses or accidents in youth and middle age depend on institutional and familial support? As has been the case for more than a quarter century, when pundits and candidates talk about the need to reform Social Security and Medicare, they typically speak in dire terms, pitching their message to one age group or another. Why do they pay so little attention to policies and programs that affect our intergenerational reserves and resources? Re-thinking policies that make sense as the median age of the population rises, altering the resilience of networks, forces us to think beyond the commonplace. If we want to improve the quality and extent of tong-term care in the U.S., we must look at private initiatives as well as public reforms at the state level. The resources that follow will assist us.

- Andy Achenbaum

A. Viewpoints: The Health Care Debate: This new series from The Kaiser Foundation features interviews with leaders of organizations representing health care providers, insurers, policymakers, employers, labor unions and consumers sharing their views on shortcomings in the nation's health care system and how it could be improved. These leaders also share their views on the prospects for change after the 2008 election and what the next President and Congress should do to make the health system work more efficiently.

B. Planning for the Future-Long-Term Care and the 2008 Election: This article from The New England Journal of Medicine outlines three key questions that the author argues the presidential candidates must inevitably confront in outlining their visions for the reform of long-term care in our country.

C. Financing the U.S. Health System-Issues and Options for Change: The Bipartisan Policy Center has released a report cataloguing the range of financing reform options that policymakers will have to consider in any major health reform effort. The report explores the principal financing alternatives proposed by presidential candidates Senator John McCain and Senator Barack Obama, as well as other systematic approaches that have been proposed to restructure the health care finance system.

D. Health Care Reform in Massachusetts-Expanding Coverage, Escalating Costs: This article from The New England Journal of Medicine examines the impact of the far-reaching health care reforms that Massachusetts enacted in April 2006.

E. How Can We Improve Long-Term Care Financing?: This brief reviews several options for reforming the system for financing and delivering long-term care in the United States. These options include enhancing private long-term care insurance, replacing the current welfare-based system with a public social insurance program, and introducing a hybrid public-private system.

IV. WORTH NOTING

A. This paper from the Urban Institute examines how potential changes in the tax treatment of retirement saving, Social Security benefits, and income from assets outside retirement accounts may affect boomers' retirement incomes. Changes in the income thresholds for taxing Social Security benefits have the largest impact on middle-income boomers, while changes in contribution limits for retirement saving plans and tax rates on capital gains and dividends have the largest impact on the highest-income boomers.

B. The Economic Slowdown's Impact on Middle-Aged and Older Americans: Results of a nationwide survey of adults age 45 and older commissioned by AARP show that a majority of respondents believe the economy is in bad shape and that many have adapted their behaviors in response to the floundering economy. And, compared to all Americans 45+, middle-aged and older Hispanics report a relatively greater impact of recent economic pressure.

C. SeniorDecision.com: The nation's largest web service providing consumer reviews and ratings of nursing homes, assisted living centers, retirement communities, and home health agencies. There is no charge to post or read reviews and advertising from senior care and housing providers is not accepted.

V. WHAT'S HAPPENING ABROAD?

A. The WHO Global Report on Falls Prevention in Older Age: The World Health Organization (WHO) has issued a report which describes the prevalence of falls around the world and provides an action plan for making progress in reducing falls among the older adult population. The model proposes specific strategies for building awareness of the importance of falls prevention and treatment; improving the assessment of individual, environmental, and societal factors that increase the likelihood of falls; and facilitating the design and implementation of culturally-appropriate, evidence-based interventions that will significantly reduce the number of falls among older persons.

B. Frameworks of Integrated Care for the Elderly: A Systematic Review: The Canadian
Policy Research Networks has released a report which presents the findings of an extensive review of models of integrated care for elders. The report identifies four common elements in successful models of integrated health and social care for the elderly that can result in improved outcomes, client satisfaction and/or cost savings or cost-effectiveness.

C. What's New in Global Aging?: This new user-friendly "Aging Everywhere" interactive world map developed by AARP International allows users to access aging-related resources by region and country.

VI. PERSPECTIVES ON POLICY: ROB HUDSON, EDITOR, PP&AR

The current issue of PP&AR explores the ways in which population aging and environmental awareness have come together in a manner that promotes both elder and environmental well-being. The connection between the two can be seen through three lenses central to the gerontological enterprise: a life-cycle view finds older people wishing to be "generative" and leave a sustainable planet; a cohort perspective sees today's elders as having contributed to and benefited from an era marked by high energy usage and damage to the environment; and an historical or period perspective brings to light the emerging issues associated with global warming and greenhouse gases.

In this issue, Rick Moody makes the case why the environment is an aging issue. His article addresses how older adults have a crucial role to play as "gatekeepers to the future" around two seemingly disparate issues: the environment and entitlements. Karl Pillemer and Linda Wagenet review the limited research literature addressing older people and the environment, taking particular note of how engaging in environmental protection activity is physically and mentally sustaining for them as well as for their surroundings. Historian Andrew Achenbaum traces elders' concern with the environment from the Scriptures through Rachel Carson, finding seniors no Johnnies-come-lately to the environmental movement. Kathy Sykes and her co-authors review initiative taken by the Environmental Protection Administration, noting in particular the EPA-supported work of LIFE (Legacy Institute for the Environment) around the Chesapeake Bay watershed. Finally, Paula Dressel documents the endeavors of the Jefferson Area Board for Aging in Charlottesville, Va., using as a metric the Viable Futures Toolkit developed by her organization, JustPartners, Inc.

This issue of PP&AR speaks to Gray and Green coming together and, in so doing, highlights the indivisibility of environmental concerns across time, generation, age, and space. To purchase the current issue of PP&AR, or to subscribe, click here.

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Newsletter Editors: Sarah Frey and Greg O'Neill, National Academy on an Aging Society; Andy Achenbaum, University of Houston.

The Public Policy and Aging E-Newsletter is supported in part by a grant from the AARP Office of Academic Affairs.