Public Policy & Aging E-Newsletter
Volume 4, Number 4, July 2010
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.
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We dedicate this issue of Public Policy & Aging E-Newsletter in celebration of the life and accomplishments of aging's mentor, Robert N. Butler, M.D. (1927-2010). Dr. Butler is justly renowned for his Pulitzer-prize winning Why Survive? (1975), for books he co-authored with his beloved wife, Myrna Lewis, as well as for coining "ageism" and "productive aging," terms that frame critical meanings we associate with growing older.
Here, we highlight some of Bob's contributions in the public-policy arena. As a young psychiatrist in Washington, DC, he fought the deinstitutionalization of elders from mental institutions and advocated community-based senior housing. As the first director of the National Institute of Aging, Dr. Butler advanced an interdisciplinary research agenda that emphasized the need for understanding Alzheimer's disease and for developing support systems to assist its victims and caregivers. In creating the first department of geriatric medicine at Mt. Sinai, Butler advanced the training of physicians and other health professionals. As always, he recruited the best talent he could find. Bob's concern with the challenges and opportunities of global aging were manifest in his networking with colleagues here and abroad through the International Longevity Center.
The field of aging has lost a towering figure. Bob showed us that big ideas must animate policymaking, that scientific research matters, that important concepts must be transmitted through all media, and that people of all ages have a vital stake in growing older in healthy ways. To his friends and mentees, Robert N. Butler has left an extraordinary legacy. It is to us, who have learned so much about how to think and act out of the box from this extraordinary man, to continue his good works.
-- Andy Achenbaum, Greg O'Neill, Sarah Frey, and Dani Kaiserman
I. WHAT’S HAPPENING IN WASHINGTON?
A. The Next Four Decades: The Older Population in the United States: 2010 to 2050: Will some segment of the older population double, triple, or quadruple over the next 40-year period? Between 2010 and 2050, the United States is projected to experience rapid growth in its older population. This Census report presents information on how the age structure of the overall population will change over the next four decades in terms of age, sex, race, and Hispanic origin. The report also examines how the projected growth of the older population in the United States will present challenges to policy makers and programs such as Social Security and Medicare.
B. Income of the Elderly Population Age 65 and Over, 2008: Using the latest available data from the U.S. Census Bureau's March 2009 Current Population Survey, the Employee Benefit Research Institute released a report reviewing the income of older Americans and how it has changed over time. The report looks at the median income levels of older adults across varying demographic groups, and how much older Americans depend on Social Security as an essential resource. Findings indicate that Social Security is the largest source of income for older Americans, accounting for almost 40 percent of their income on average.
C. Older Americans in Poverty: A Snapshot: This AARP report examines the persistent problem of elderly poverty in the United States, and provides valuable data on older adults in poverty-who they are, where they live, and the challenges they face affording basics like food, housing, and health care. It highlights wide variation in poverty rates by race and ethnicity, age, sex, geographic location, and marital status, and describes the reliance of older poor and low-income families on Social Security. The report also examines problems with the current poverty statistic measure and describes a proposal to modernize it in order to provide a more accurate assessment of how many people-including older adults-encounter severe economic hardship.
II. WHAT’S HAPPENING AROUND THE COUNTRY?
A. Health Reform and Your Community: State By State Fact Sheets: The White House provides state by state fact sheets on the immediate benefits of the Affordable Care Act within each state. Each state's timeline lists specific dates for implementing provisions of the Act, including insurance for individuals with pre-existing conditions, support for health coverage for early retirees, and new Medicaid options. The fact sheets detail how older Americans are expected to benefit from lower costs, improved quality of care in nursing homes, and protections from abuse and neglect. Additionally, a White House overview of what health reform means for older Americans can be found here.
B. Age4Action Network to Host Older Americans Act Idea Forums in Multiple States: The Age4Action Network, a national community to promote 50+ civic engagement, will host Idea Forums around the country in anticipation of the 2011 reauthorization of the Older Americans Act. Community members and leaders in civic engagement will offer suggestions for improving the law's expansion of opportunities for older Americans to engage in work, service, lifelong learning, and leadership. The ideas collected will be summarized and shared with Congress prior to reauthorization. Idea Forums already have been held in Las Vegas, NV, on June 3 and in Philadelphia, PA, on June 22. Additional forums to be held later this summer include: St. Paul, MN, July 12; Denver, CO, July 20; St. Louis, MO, July 22; Los Angeles, CA, July 27; and Washington, DC, TBD.
C. NIH Dollars Awarded by State: The Department of Health and Human Services released an interactive map on how much funding each state receives from the National Institutes of Health (NIH). As the main source of grants for aging research, NIH funding has important implications for research on topics like Alzheimer's disease, Parkinson's disease, and osteoporosis. In addition to an overview on state funding, the map also breaks down the data by organization or institution receiving the funding, amount of funding, and congressional district. To view grants for projects funded by the Recovery Act, click here.
III. THIS ISSUE'S MAJOR POLICY STORY: THE COSTS OF AN AGING SOCIETY
Three decades ago we would have entitled this section "Can We Afford Old People?" Peter Peterson, Daniel Callahan, and younger kindred spirits were forecasting that elders would bankrupt the economy. "Greedy Geezers" were draining health resources and social services, they claimed, which would leave their children and grandchildren with little money and bleak prospects. Nowadays it seems unlikely that generational warfare will rend the nation asunder. Still, like it or not, Americans of all ages must think out of the box as increasing numbers of Boomers contemplate retirement and become eligible for Medicare. "The Costs of an Aging Society" provides the latest information about some critical economic and health-care issues, but it also invites readers to consider other transgenerational features--such as transportation costs and spending on disability--as we revisit the priorities that inhere in an aging society.
--Andy Achenbaum
A. Social Security and the Budget: Although the costs of Social Security are only expected to rise by 2 percentage points of America's GDP from 2007 to 2030, many of government's other programs, as well as private expectations about when to retire, employer design of pensions, and seniority pay, depend on Social Security provisions. This Urban Institute report examines these costs related to Social Security, which have far-reaching implications of Social Security reform. If effective, implementing reforms can generate higher national output, personal income, and revenues for Social Security-helping the nation achieve budget sustainability and a stronger Social Security system.
B. Changing the Trajectory of Alzheimer's Disease: A National Imperative: This Alzheimer's Association report examines the current and projected costs associated with the Alzheimer's crisis, as well as potential Medicare and Medicaid savings if disease modifying treatments were available. Total costs of care for individuals with Alzheimer's disease by all payers will soar from $172 billion in 2010 to more than $1 trillion in 2050, with Medicare costs increasing more than 600 percent, from $88 billion today to $627 billion in 2050. The report shows that Medicare and Medicaid can achieve dramatic savings - and lives could be improved significantly -through incremental treatment developments in delaying the onset of the disease or slowing the progression of the condition.
C. Medicaid Coverage and Spending in Health Reform: National and State-By-State Results for Adults at or Below 133% FPL: This Kaiser Commission on Medicaid and the Uninsured report shows the National and State-by-State costs associated with the expansion of Medicaid under the health reform law. This expansion will increase significantly the number of people covered by the program and will reduce the uninsured, with the federal government picking up the majority of the cost. The analysis is among the first to address Medicaid coverage and spending for all 50 states and the District of Columbia. To view the executive summary of the findings, click here.
D. National Spending for Long-Term Services and Supports: This National Health Policy System report presents data on long-term services and supports (LTSS) spending by major public and private sources. LTSS for the elderly and younger populations with disabilities are a significant component of national health care spending. In 2008, spending for these services was almost 10 percent of all U.S. personal health care spending, most of it paid by the federal-state Medicaid program. Services may include adult day care programs, assisted living facilities, and nursing home care.
E. Funding the Public Transportation Needs of an Aging Population: The American Public Transportation Association released a report showing that a greater public investment is required in order to accommodate the needs of the growing older population. Additional outlays would go towards addressing the increased operational needs of the emerging senior population, including more bus operator training, better route planning, and coordination with transportation providers. The report also recognizes the need to expand public transportation systems to better fit community needs and comply with the Americans With Disabilities Act.
IV. WORTH NOTING
A. The President Talks to Seniors About the Affordable Care Act - and Doughnuts: On June 8th, the President hosted a tele-town hall to discuss how the Affordable Care Act will impact seniors. The opening remarks addressed the timetable for implementing provisions of the Act, including immediate rebate checks to assist with the prescription coverage doughnut hole and implementation of future preventive care services. During the session the President answered questions and addressed claims of "death panels" and Medicare benefit cuts. He assured older adults that their Medicare benefits would be protected, and that they could keep their doctors.
B. A Toolkit for Serving Diverse Communities: The U.S. Administration on Aging released a toolkit providing the aging network and its partners with a replicable and easy-to-use method for providing respectful, inclusive, and sensitive services for any diverse community. The toolkit consists of a four-step process and a questionnaire that assists professionals, volunteers and grassroots advocates with every stage of program planning, implementation and service delivery for older adults, their families, and caregivers. This toolkit invites the aging network to make a cultural shift in service provision and to appreciate fully the diversity within older adult communities.
C. The MetLife Retirement Readiness Index: Are Americans Prepared for the Transition? While many events will influence the specific timing and even the manner in which an individual enters retirement, research on this critical process has demonstrated that a successful transition into retirement involves personal, career, and financial transitions that are associated with the completion of 15 specific developmental tasks. This Metlife study identifies characteristics such as age, number of years to anticipated retirement, and retirement status that were most associated with completion of various tasks prior to leaving the workforce.
V. WHAT'S HAPPENING ABROAD?
A. Ageing in the European Union: Where Exactly? This Eurostat report describes the pattern of ageing across the European Union due to a growing number of older adults and decreasing number of children. Variations in this trend exist across different EU Member States, districts, and areas. For example, rural areas are losing young generations more quickly than urban areas and in recent years the percentage of older adults has grown faster in urban areas than in rural areas.
B. Japan's Demographic Future: The Population Reference Bureau projects that by 2055, 41 percent of Japan's population of 90 million will be 65 or older. Their report illustrates how the unprecedented number of older Japanese may impact workforce and immigration policies. Additionally, Japan must consider the costs associated with a growing number of retirees and individuals needing long-term health care.
C. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update: Despite having the most costly health system in the world, the United States consistently underperforms on most health outcome measures relative to other countries. This Commonwealth Fund report--an update to three earlier editions--includes data from seven countries and incorporates patients' and physicians' survey responses on care experiences. Compared with six other nations-Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom-the U.S. health care system ranks last or next-to-last on five dimensions of a high-performance health system: quality, access, efficiency, equity, and healthy lives. To view an interactive web comparison of health system performance, click here.
VI. PERSPECTIVES ON POLICY: ROB HUDSON, EDITOR, PP&AR
The latest issue of Public Policy & Aging Report, sponsored by the Benjamin Rose Institute on Aging, brings attention to the important changes in long-term care policy over the last few decades. After years of only modest movement, the ground under long-term care policy is shifting to include expanding eligibility, flexible and innovative benefits, stronger financial mechanisms, and greater consumer choice. Pamela Doty's introductory essay provides a 30-year review of the evolutionary process, and identifies how the enactment of the CLASS Act represents new changes in the insurance market. Lori Simon Rusinowitz and colleagues discuss consumer-directed initiatives as a truly innovative development in service delivery. Maturation of the service delivery system is seen also in the new capacities of aging network agencies to manage community-based services as demand and financing for them increase, as noted by Suzanne Kunkel and Abbe Lackmeyer. Workforce issues continue to be a major concern, and the work of the national panel reported here by Benjamin Rose Institute researchers sets forth concrete steps that can be taken. Miriam Rose and colleagues review state-level initiatives in home and community care, and researchers at Miami University put Ohio's long-term care system under the microscope.
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Newsletter Editors: Dani Kaiserman, 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.