Volume 6, Number 3, May 2012 (Topic: Aging In and Out of Communities )

Public Policy & Aging E-Newsletter

Volume 6, Number 3, May 2012

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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I. WHAT’S HAPPENING IN WASHINGTON?

A. 2012 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance (OASDI) Trust Funds: This OASDI report presents the current and projected financial status of the trust funds. Social Security and Medicare are the two largest federal programs, accounting for 36 percent of federal expenditures in fiscal year 2011. Both programs will experience cost growth substantially in excess of GDP growth in the coming decades due to aging of the population and, in the case of Medicare, growth in expenditures per beneficiary exceeding growth in per capita GDP. Click here to view the summary.

B. Key Issues in Understanding Economic and Health Security of Current and Future Generations of Seniors: As part of broad deficit-reduction plans, policymakers are considering reforms to the nation's three major entitlement programs–Medicare, Medicaid, and Social Security–that could significantly affect the economic security of seniors in their retirement years. This Kaiser Family Foundation brief examines the role of these programs in ensuring seniors' financial security as well as the challenges facing current and future generations when it comes to economic and health security. The brief includes a special focus on seniors with low-to-moderate incomes, who are more likely to be women, black, and Hispanic.

C. The Impact on Inequality of Raising the Social Security Retirement Age: There have been a number of proposals in policy circles that involve raising the Social Security retirement age. These proposals are viewed as both a way to reduce or eliminate the projected shortfall in the program and also a response to projected increases in longevity. This Center for Economic and Policy Research report examines the impact of an increase in the retirement age on various demographic groups and finds that an increase in the retirement age, like any other cut in benefits, will have the effect of increasing inequality.

II. WHAT’S HAPPENING AROUND THE COUNTRY?

A. 2012 Alzheimer's Disease Facts And Figures: This Alzheimer's Association report estimates the prevalence of Alzheimer’s and the number of deaths caused by Alzheimer’s in every state. Report findings show that costs for people with Alzheimer's will total $200 billion this year, including $140 billion in care paid for by Medicare and Medicaid. In addition to sharing demographic information on a state-by-state basis, the report includes a special section on those with Alzheimer’s who live alone and discusses policy implications associated with caregiving and rising health care costs.

B. Characteristics and Use of Home Health Care by Men and Women Aged 65 and Over: Based on data from the 2007 National Home and Hospice Care Survey, this Centers for Disease Control and Prevention report presents national estimates on differences in the use of home health care between men and women aged 65 years and over. Findings show that in the United States, men aged 65 years and over used home health care at a lower rate than women. Among home health care patients 65 years and over, women were more likely to be 85 years and over while men were more likely to be married and receive home health care as post-acute care. These findings may assist health care provider policies in targeting specific areas characteristic of the population aged 65 and over.

C. Obesity, Chronic Diseases Stable Across U.S. States in 2011: The Gallup-Healthways Well-Being Index analysis highlights the relationship between high obesity rates and poor health outcomes across states, including high rates of chronic diseases, more headaches, and more pain. The data looks at rates of obesity, high blood pressure, diabetes, and other chronic diseases across states. Findings show that obesity rates remain highest in many Southern and Midwestern states.

III. THIS ISSUE'S MAJOR POLICY STORY: AGING IN AND OUT OF COMMUNITIES

That we are including seven articles to buttress this issue’s “Major Policy Story” underlines two trajectories that will converge over the next decade. On the one hand, it is quite evident that the choices and preferences made by Baby Boomers about what they want and what they hope to get vary enormously as they collect cards from AARP and Medicare. Some built McMansions in the prime of life and acquired time shares or lake property. Others lost their homes in the recession. Still others took shelter with family or low-income housing; prisons can be old-folks homes. On the other hand, we know that the checklists used by older people, who want to maintain independence in secure, accessible dwellings, often differ from the requirements of couples with young children. Today’s older Americans, regardless of age or ability, are less inclined than their parents to seek age-segregated facilities in which to spend their remaining days. For many, it is more meaningful and cost effective to remain at home in familiar (if somewhat modified) settings.

-Andy Achenbaum

A. Demographic Challenges and Opportunities for U.S. Housing Markets: Fewer seniors are disabled and more of them are financially independent, but the sheer size of the Baby Boom generation means that a large increase in the absolute number of seniors facing housing affordability and independent living challenges is inevitable. Aging is likely to pose special housing challenges for renters, minorities and rural Americans. This Bipartisan Policy Center report concludes that decisions about the shape of housing policy in the U.S.–especially the finance system and tax incentives for owner-occupied and rental housing–stand to have a potentially large effect on the shape of the future U.S. housing market.

B. Old Behind Bars: Aging Prison Population: This Human Rights Watch report presents new data on the number of aging men and women in prison; provides information on the cost of confining them; and offers an overview of some ways that prison systems have responded to them. The report tackles policy considerations posed by incarcerating elderly inmates, and raises the human rights concerns that must be addressed if sound policies are to be developed for the criminal punishment and incarceration of older prisoners, both those who grow old in prison and those who enter at an advanced age.

C. Housing an Aging Population–Are We Prepared?: With the population of individuals aged 65 and older expected to increase 120 percent from 40 million to more than 88 million by 2050, demand for housing will shift dramatically and the need for services to help older adults age in place will grow exponentially. This Center for Housing Policy report looks at the housing situation of older adults now and implications for the near future. It includes a detailed analysis of data from the most recent American Housing Survey and presents results by age group (65-74, 74-84, 85+) because the housing needs of “younger” older adults and the oldest adults are quite different.

D. Residents Living in Residential Care Facilities in the US: 2010: In 2010, residential care residents were mostly female, non-Hispanic white, aged 85 and over, and had a median length of stay of about 22 months. This Centers for Disease Control and Prevention report presents national estimates of people living in residential care facilities (RCFs), using data from the first-ever national probability sample survey of RCFs with four or more beds. The demographic profile of residential care residents may provide useful information to policymakers, providers, and consumer advocates as they plan for the future long-term care needs of older as well as younger adults.

E. National Spending for Long-Term Services and Supports: Long-term services and supports (LTSS) for the elderly and younger populations with disabilities are a significant component of national health care spending. In 2010, spending for these services was $207.9 billion (8 percent of all U.S. personal health care spending), most of it paid by the federal-state Medicaid program. This National Health Policy Forum brief shows how the rapid spending increases as the “baby boom” population ages, along with the potentially enormous costs of care to individuals and families, will likely lead policymakers to continue to review these issues in coming years.

F. Costs and Concerns among Residents in Seniors Housing and Care Communities: Evidence from the Residents Financial Survey: Despite the general impression that seniors housing and care communities are very costly, less is known about what types of costs residents of these communities are facing and how they pay their expenses. To fully understand the current and future economic situation, the Center for Retirement Research designed and conducted a new survey, the Residents Financial Survey (RFS). This paper uses the RFS to explore the costs associated with seniors housing and care communities, how individuals pay these costs, and how payment methods are related to how long they have been living in their current community.

G. New Visions for Aging in Place: In Independent for Life, former Housing and Urban Development Secretary Henry Cisneros and a team of experts on aging, architecture, construction, health, finance, and politics, assess the current state of housing and present new possibilities that realistically address the interrelated issues of housing, communities, services, and financial concerns. This book chapter from Independent for Life is written by Henry Cisneros and covers demographics of an aging population, adaptations of existing housing, and planning new communities to age in place.

IV. WORTH NOTING

A. The Administration for Community Living: On April 16th, Secretary Kathleen Sebelius announced a new organization within the Department of Health and Human Services–the Administration for Community Living (ACL). The ACL will include the efforts and achievements of the Administration on Aging, the Office on Disability, and the Administration on Developmental Disabilities in a single agency with the goal of increasing access to community supports and full participation, while focusing attention and resources on the unique needs of older Americans and people with disabilities.

B. More U.S. Children Raised by Grandparents: This Population Reference Bureau report shares how growing numbers of children in the United States are living with a grandparent, and how these changes impact caregiving policies and services. In 2010, about one in 14 U.S. children lived in a household headed by a grandparent–for a total of 5.4 million children. These grandparent-headed households have helped fuel the rise in multigenerational households, a category that includes households with and without minor children.

C. Respecting Our Elders: The Case for Preserving and Expanding the Senior Community Service Employment Program: In 2011, unemployment rates for persons aged 55-74 ranged from a high of 20 percent among the lowest income workers with an annual income under $20,000 to nearly ten percent for those in low-middle income households. This Spotlight on Poverty and Opportunity commentary highlights a program that assists unemployed low-income older adults, the Senior Community Service Employment Program (SCSEP), and the funding danger currently facing it.

V. WHAT'S HAPPENING ABROAD?

A. India's Aging Population: India's population ages 60 and older is projected to increase dramatically over the next four decades, from 8 percent in 2010 to 19 percent in 2050, according to the United Nations Population Division. This Population Reference Bureau e-newsletter highlights some of the recent research that can inform policy decisions as India and other developing countries plan for aging societies.

B. Working After Age 65: What is at Stake?: It is argued by some that eligibility for Old Age Security (OAS) and the Guaranteed Income Supplement (GIS) at age 65 discourages older Canadians from remaining in the workforce, and that we need to keep them working longer to avoid present and future labour shortages. Accordingly, the federal government proposes to phase-in an increase in the age of eligibility from age 65 to age 67, affecting Canadians who are now 54 and younger. This Canadian Centre for Policy Alternatives paper looks at some of the realities of working past age 65, and examines what an increase in the OAS eligibility age will mean for those who will have no choice but to work longer in the future.

C. Entitlement Reforms in Europe: Policy Mixes in the Current Pension Reform Process: Many European countries have begun programs intended to reduce the growth of entitlement programs, in particular of public pensions. Current costs are high, and the pressures will increase due to population aging and negative incentive effects. This National Bureau of Economic Research paper focuses on the pension reform process in Europe. It links the causes for current problems to the cures required to make the pay-as-you-go entitlement programs in Continental Europe sustainable above and beyond the financial crisis.

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

This month’s theme of “Aging In and Out of Communities” calls to mind a recent issue (Volume 19, Number 1) of Public Policy & Aging Report that explores "Livable and Sustainable Communities." The issue reviews both the current status of community-based housing options for older adults and some of the controversies associated with those options.
In the lead article, Jon Pynoos and Caroline Cicero track the United States' progress in the development of aging-friendly communities. These include home modification and community-level innovations designed to lessen isolation and increase social interaction. Stephen Golant's article offers support for appropriate community alternatives for seniors, while suggesting that "aging in place" may be an inappropriate option for many elders due to flawed data about its actual appeal, financial barriers, and local policies promoting aging in place. Next, Kathryn Lawler and Cathie Berger explore the Atlanta Regional Commission (ARC)'s engagement in comprehensive planning and design activities to promote the idea that "place matters." Finally, Andrew Blechman profiles "The Villages," an age-restricted community in central Florida. He critiques this upscale option, noting that private ownership impinges on traditional public functions and that troublesome intergenerational and racial issues lurk in the background of such a community.

To purchase this issue of PP&AR, click here. To subscribe, simply click here to order online or download the subscription order form.

For several years the masthead of this e-newsletter has featured the names of Sarah Wilson and Dani Kaiserman. Readers should know that this pair of enthusiastic, astute, and most able editors did the lions’ share of the work in compiling and preparing these issues, six times a year. Their diligence made it possible for the rest of us to be assured that we were getting timely and balanced perspectives on aging-related policy developments in Washington, in other states, and across the globe. It is time for them to leave their posts and take on fresh challenges. I will miss them greatly. I am sure you join me in thanking them for all they did and do, and in wishing them much success.

-Andy Achenbaum

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Newsletter Editors: Dani Kaiserman 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. The views expressed are those of the authors and not necessarily those of The Gerontological Society of America, the National Academy on an Aging Society, or the AARP Office of Academic Affairs.