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Helping Aging Baby Boomers
to Help Themselves
The Commonwealth Fund
May 17, 2005
The Bush Administration remained mum about the specifics, but said Tuesday that its most important goal in the upcoming reauthorization of the Older Americans Act is modernizing long-term care for the Baby Boomer generation.
Among the elements of modernization: more individual responsibility for financial planning; greater emphasis on managing one's health; and fostering home- and community-based care to reduce favoritism toward nursing home care.
"We will pursue changes that recognize that we cannot wait until people are old and frail and poor to begin to address their long-term care," Assistant HHS Secretary for Aging Josefina Carbonell told the Retirement Security Subcommittee of the Senate Health, Education, Labor and Pensions Committee.
"This will require that those who are not old should plan for their own long-term care. It will require the elderly who are not poor to make creative use of their existing resources to finance and support their care, with limited government assistance, to prevent poverty and the loss of independence."
Carbonell told Subcommittee Chairman Sen. Mike DeWine, R-Ohio, that the administration may announce more detailed goals for reauthorization of the 40-year-old legislation in the next month. The legislation pays for nutrition, health care, and employment assistance programs assisting the elderly through community senior centers, Meals on Wheels programs, and other means.
Reauthorization of the Act in the year 2000 added the National Family Caregiver Support Program to provide respite care and other assistance to individuals acting on their own to provide long-term care.
Carbonell said reauthorization should promote awareness and use by individuals of long-term care insurance and home equity programs to finance their own long-term care.
"Home equity instruments such as reverse mortgages enable older people to tap into the equity in their homes," she said in written testimony. "It is estimated that 45 percent of households at financial risk of 'spending down' to Medicaid could take advantage of a reverse mortgage to help them pay for long-term care."
Promoting better health is another way of modernizing health care for the elderly, she said. The HHS Administration on Aging aims in part to do that by enrolling seniors, particularly those with low incomes, in the upcoming Medicare prescription drug benefit.
It seeks the "active support of at least 10,000 of our community-based aging services provider organizations in helping older people learn about and take full advantage of the new coverage," Carbonell said. Meals on Wheels and other volunteers will assist in the effort, she said.
Another goal of the reauthorization is to foster "evidence-based" health promotion and disease prevention programs and practices "that delay and prevent the chronic conditions that are known to result in disability among the elderly."
Examples include a six-week training program to help people with chronic conditions better manage their own health in a way that reduces use of hospital and doctor care and a program developed at Yale University that trains the elderly to reduce falls by improving balance, gait, and posture; managing their medications; and removing hazards in the home such as slippery rugs.
Some 8.2 million Americans are assisted by the network of state and local government offices, local organizations, and volunteers carrying out programs under the Older Americans Act. Of these, 3 million are getting services in their home that keep them out of nursing homes, Carbonell said.
The network "manages almost two-thirds of this nation's Medicaid investment in community-based long-term care for the elderly, she said. The Act "should now be modernized to help this network and the country adapt to the challenges of sustaining community-based long-term care."
Carbonell agreed under questioning by Sen. Barbara Mikulski of Maryland, the ranking Democrat on the subcommittee, that the National Family Caregiver Support Program has become one of the "pillars" of the system created by the Act. In addition to giving caregivers a break by funding limited care for the frail and disabled by other individuals, the program provides counseling and training and information on local long-term care resources.
The Administration on Aging originally projected that 250,000 caregivers would find assistance through the program, but the total in 2003 reached almost 600,000. Mikulski said she aims to double funding of the program from $125 million to $250 million.
Questioning by DeWine and Mikulski suggested that their reauthorization priorities include greater help for elderly Americans in finding work in the private sector, including those in the auto and steel industries who have been abruptly laid off. DeWine said he plans a series of hearings on the reauthorization and that part of the process will be reviewing recommendations expected later this year from the White House Conference on Aging.
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