Tag Archives for Aging and Disability Resource Center

Senators Collins, Casey, Pushing for Reauthorization of Older Americans Act

Published in Woonsocket Call on May 19, 2019

With the Older Americans Act (OAA) scheduled to expire on September 30, 2019, the U.S. Special Senate Committee on Aging puts the spotlight on the importance of this critical law to older American’s, calling for its reauthorization.

Enacted in 1965, the OAA helps more than 11 million seniors age in their communities by funding programs that support grandparents raising grandchildren, reduce social isolation, provide congregate or home-delivered meals and offer respite care among other services.
OAA was last reauthorized in 2016 for a period of three years.

Bipartisan Push in Senate to Reauthorize OAA

While the Senate Aging Committee does not have legislative jurisdiction over OAA, the panel traditionally has put attention on the OAA by holding hearings or special events at the start of any reauthorization process. And the Chair and Ranking Member of the Senate Aging Committee – Senators Susan Collins (R-Maine) and Robert Casey (D-Pa.)—have taken an especially keen interest in this year’s OAA reauthorization process. The Senators are leading a bipartisan coalition of Senators pushing for reauthorization, which includes Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wa) as well as Senators Mike Enlzi (R-Wyo.) and Bernie Sanders (I-Vt.).

In Collin’s opening statement, she pledged to “get across the finish line, on time, a robust and bipartisan Older Americans Act that will strengthen support for its bread and butter programs, while providing more flexibility for states to meet local needs.”

At the Senate Aging hearing, Collins says she plans to focus on five priority areas in the reauthorization of OOA, specifically family caregivers, nutrition, social isolation, transportation and elder justice. “By enriching the lives of seniors, the Older Americans Act improves the lives of all Americans,” says the Maine Senator, kicking off the two hour and 26-minute hearing, aptly titled, “The Older Americans Act: Protecting and Supporting Seniors as they Age.”

“The Older Americans Act is a shining example of a federal policy that works. Every $1 invested into the Older Americans Act generates $3 to help seniors stay at home through low cost, community-based services,” says Collins.

“The Older Americans Act reminds us who we are as a country. It represents our commitment to the generations who made us who we are today. And, it lifts up the seniors who need our help the most, added Casey in his opening statement.

Before the May 18 hearing, Casey noted that he had reached out to 34 Area Agencies on Aging, representing 60 percent of the counties in his home state, for their feedback about OAA’s effectiveness in delivering services to older Pennsylvanians. He asked these two questions: “How is the OAA currently working?” and “How should this important law be strengthened?”

“In every city and every town, the aging network said that there is no match for the high-quality services that senior centers and Area Agencies on Aging provide to older Pennsylvanians. The OAA programs support Pennsylvanians and their caregivers by providing meals, respite and protection from fraud and abuse. And importantly, the OAA also helps seniors age in the location of their choice, which of course is most often their homes and communities.”

Senate Panel Witnesses Give Thumbs-up to OAA

Larry Gross, the chief executive officer of the Southern Maine Agency on Aging shared with the attending Senators his more than four decades of experience serving seniors in both urban and rural areas. He explained how OAA bolsters nutrition programs, supports family caregivers, reduces social isolation and addresses elder justice. He highlighted a partnership with Maine Medical Center showing that home-delivered meals reduce hospital readmissions, and discussed innovations that he has led to improve senior nutrition and build community.

Faith Lewis, a great-grandparent from Simpson, Pennsylvania, shared her personal experience raising her 5-year-old great-granddaughter and the importance of OAA program support that assist grand families like hers. She receives support through the National Family Caregiver Support Program and regularly attends a support group for grandparents raising grandchildren that is hosted by her local Area Agency on Aging.

Lance Robertson, the Administrator & Assistant Secretary for Aging at the administration for Community Living, gave an overview of OAA, including its history, sustainability, and variability across states and communities. He shared background and data on how OAA has helped millions of seniors to age in their local communities. He also discussed his agency’s mission to connect people to resources, protect rights and prevent abuse, expand employment opportunities, support family caregivers and strengthen aging networks.

Finally, Richard Prudom, the Secretary of Florida’s Department of Elder Affairs, Mr. Prudom talked about his work with his state’s 11 Area Agencies on Aging. He offered a state perspective on interfacing both with the administration for Community Living as well as with the Area Agencies on Aging to develop programs that meet the needs of communities. He focused on priorities in supporting family caregivers, advancing senior nutrition, combating elder abuse and addressing disaster preparedness.

AARP Talks About Impact of OAA Programs

Wendy Fox-Grage, Senior Strategic Policy adviser at the Washington, DC-based AARP, in a Feb 19 blog posting, says that despite “woeful inadequacy of current funding, OAA enables 11 million older Americans to live independently. Recent evaluations confirm the positive impact on the Act’s nutrition and family caregiver program, she says.

As to evaluating the impact of OAA’s nutrition programs, Grage says that forty-two percent of congregate meal participants and 61 percent of home delivered meal participants would skip meals or eat less in the absence of these programs. Congregate meal participants are also less likely to be admitted to nursing homes, and congregate meal participants who live alone are less likely to be admitted to hospital than nonparticipant, she says.

As to caregiving, Grage noted that family caregivers received four hours or more of respite care per week reported a decline in burden over time and those who received at least one education/training, counseling, or support group session experienced an increase in self-reported confidence over time.

AARP joins Senators Collins and Casey’s call on Congress to reauthorize the Older Americans Act before the end of September. OAA’s 11 million beneficiaries, 700,000 caregivers, and providers in the nation’s aging network — consisting of the federal Administration on Aging, State Units on Aging, local Area Agencies on Aging, and local service providers – also wait for Congress to make its move and reauthorize the Act.

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Rethinking Rhode Island’s LTC Delivery System

Published in the Woonsocket Call on April 12, 2015

AARP Rhode Island releases a state-specific analysis, of the 2014 edition of “Raising Expectations: A State Scorecard on Long-Term Services and Supports (LTSS) for Older Adults, People with Physical Disabilities, and Family Caregivers” that just might give state officials cause for concern, a low rating on its long-term care delivery system, when compared to other states.

The 2011 Scorecard was the first multidimensional assessment of state performance of LTSS. Like this earlier version, the release of the 109 page 2014 report, referred to as the LTSS Scorecard, and its state-specific analysis (prepared by policy consultant Maureen Maigret), measuring how well the nation and each of the states is doing in providing long-term care services, does not bode well for the nation’s littlest state. It finds the Ocean State ranks 38th nationally on 26 performance indicators, with it achieving the lowest rank of all New England States.

“Our analysis provides a closer look at where Rhode Island is keeping pace and where we fall short,” said AARP State Director Kathleen Connell. “The report indicates that, as the state with the highest percentage of persons 85 and older, we face exceptional challenges. It is our hope that the General Assembly and state policymakers find the analysis to be a valuable tool,” she says.

Failing Grades

The 2014 LTTS Scorecard indicates that Rhode Island:

• Ranks 4th highest among states in nursing home residents per 1,000 persons age 65 and over

• Has a high percent of low-care nursing home residents and spends a far higher percent of its LTSS dollars than the national average on nursing home care as opposed to home and community-based services.

• Has some of the highest long-term care cost burdens in the country making private pay long-term services unaffordable for the vast majority of older households.
But, on a positive note, the state-specific analysis noted that Rhode Island’s best progress was made in the Legal and System Supports dimension largely due to the 2013 passage of the Temporary Caregiver Insurance program and Caregiver Assessment requirements for Medicaid Home and Community Based Services (HCBS).

In addition, to revisiting the 19 recommendations made following the release of AARP’s 2011 Scorecard, the more recent 2014 analysis recommends five new major policy initiates to improve the littlest state’s LTSS. Among the recommendations: funding of an Aging and Disability Resource Center; the developing an online benefits screening tool to allow access to income-assistance benefits and conducting outreach programs to increase participation; reviewing the Rhode Island’s Nurse Practice Act to allow nurse delegation of certain health maintenance and nursing tasks to direct care workers; requiring hospitals to provide education and instruction to family caregivers regarding nursing care needs when a patient is being discharged; and exploring emerging medical technologies to better serve home and community based clients.

The current analysis finds that only four recommendations out of the 2011 recommendations have been implemented, most notably those to promote coordination of primary, acute and long-term care and to strengthen family caregiver supports.

Meanwhile, only six recommendations were partially implemented, including the expansion of the home and community co-pay program and authority (but not implementation) under the 1115 Medicaid waiver renewal to provide expedited eligibility for Medicaid HCBS and for a limited increase in the monthly maintenance allowance for persons on Medicaid HCBS who transition out of nursing homes. Finally, nine recommendations, although still relevant, have not been implemented.

Response and Comments

Responding to the release of AARP’s 2014 Scorecard and state-wide analysis, Governor Gina Raimondo says, “we need to ensure that we have a strong system of nursing home care for those who truly need those services, but we must invest our Medicaid dollars more wisely to support better outcomes. We cannot continue to have the fourth highest costs for nursing home care (as a percent of median income of older households) and also rank near the bottom of all states in investments in home and community-based care.”

According to Raimondo, the state’s Working Group to Reinvent Medicaid is looking closely at AARP’s Scorecard and state-specific analysis and Rhode Island’s spending on nursing home and long-term care. Health & Human Services Secretary Elizabeth Roberts has directed her staff to look directly at the proposals recommended by AARP Rhode Island.

“I expect the Working Group will include specific proposals stemming from these findings in their April budget recommendations and their long-term strategic report they will complete in July,” says the Governor.

AARP Rhode Island Executive Director Connell, representing over 130,000 Rhode Island members, was not at all surprised by the findings of the recently released 2014 Scorecard. “Based on benchmarks set in the 2011 Scorecard, it was apparent that there was much work to do,” she says, recognizing that there are “limited quick fixes.”

“Some steps in the right direction will not lead to an immediate shift in the data. This is a big ship we’re trying to steer on a better course. We were encouraged, however, by ‘improving’ grades for lower home-care costs and the percentage of adults with disabilities ‘usually or always’ getting needed support rising from 64 percent to 73 percent,” adds Connell.

Connell says that the Rhode Island General Assembly is considering legislation to improve the delivery of care, which might just improve the state’s future AARP ‘report’ cards.” “In this session, there is an opportunity to improve long-term supports and services with passage of several bills, including one that would provide population-based funding for senior centers,” she says, stressing that it’s a “responsible investment that will help cities and towns provide better services.”

Connell adds, “The proposed CARE Act gives caregivers better instruction and guidance when patients are discharged and returned to their homes. This can be a cost saver because it can reduce the number of patients returned for treatment or care.”

The larger mission for state leaders is the so-called ‘re-balancing’ of costs from nursing care to home to community-based care. That’s where real savings can occur and home is where most people would prefer to be anyway.”

Finally, Virginia Burke, Executive Director of the Rhode Island Health Care Association, a nursing facility advocacy groups, supports the implementation of the policy initiatives recommended by AARP’s state-specific analysis. But, “The primary driver of our state’s nursing facility use is the extremely advanced age of our elders,” Burke says, noting that the need for nursing facility care is more than triple for those aged 85 and older than for seniors just a decade younger. Due to the state’s demographics you probably won’t see a change of use even if you put more funding into community based home services, she adds.

Governor Gina Raimondo and the General Assembly leadership will most certainly find it challenging to show more improvement by the time the next Scorecard ranks the states. Older Rhode Islanders deserve to have access to a seamless system, taking care of your specific needs. Creative thinking, cutting waste and beefing up programs to keeping people in their homes as long as can happen might just be the first steps to be taken. But, the state must not turn its back on nursing facility care, especially for those who need that level of service.

Herb Weiss, LRI ’12 is a Pawtucket writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com.