AARP Report Says Older Americans Value Livable Communities

Published n Pawtucket Times, May 16, 2014

If they had their druthers, the vast majority of people age 50 and older plan to remain living independently right at home in their communities “aging in place”, concludes a new report released last month by the AARP Public Policy Institute. The 43 page report which surveyed boomers and seniors found that both value secure neighborhoods, safety, good schools, safe streets for walking, access to transportation, parks and affordable housing as community amenities. With these resources in place, communities enhance personal independence and foster resident engagement in civic, economic and social life, qualities that AARP has traditionally used to describe the livability of a community.

“What older Americans and Millennials want in terms of their community is not all that different.” said AARP Executive Vice President for Policy, Debra Whitman. “What is livable differs for each of us, whether we want a warm climate or a dense city, for example,” she said. “But this report tells us that the fundamental elements of a community that will please America’s aging population will equally serve future generations [as well].”

Maintaining Independence in the Community

The new report, “What is Livable? Community Preferences of Older Adults,” unveiled April 25, 2014, is based on focus groups and a survey of more than 4,500 participants. These findings reaffirm the historic trend that most people ages 50 and older want to age in place. Adults ages 65 and older are even more likely (87 percent) to say they want to age in their current home or community than those ages 50 to 64 (71 percent).

A small portion of adults age 50 and older – about one in six – say they plan to move in the next three years. This thought is more common for members of minority groups, those with low-incomes, those who don’t drive, or those living in metropolitan areas, notes the report.

According to the AARP report, many factors play into the hierarchy of a person’s community preferences. Specifically, household income influences the importance of local government spending priorities on local schools, transportation, personal safety, and proximity to various amenities. Race and ethnicity also play a role as do health and one’s life stage. African-American and Latino respondents ranked affordable housing more highly than respondents in general, for example, while caregivers and people with disabilities rate the availability of specialized transportation more highly than those who are not in those categories.

Participants were also asked, “What community amenities do you want close to home?” Access to public transportation, food and green space topped the list, the researchers say.

Effectively Planning for Livable Communities

Jeff C. Davis, Principal Planner at the Rhode Island Division of Planning, notes that AARP’s report mirrors his state agency’s views as what is a livable community. State planners’ strategy is to identify and promote areas where Rhode Island should grow – places in the state that already have a core of residential and commercial development or are well suited to planned, future development; they are the places that will accommodate and nurture Rhode Island’s future growth while protecting its natural and cultural resources.

According to Davis, livable communities can be found in downtown places like Providence, Westerly, Newport and Warren and in villages like Wickford, Harrisville, Wakefield and Pawtuxet. “These places offer a mix of homes, shops, community services, jobs, and public open space, connected not just by roads, but bus routes, bike paths, and in some cases trains,” states Davis, stressing that the Ocean State is also “very fortunate that a lot of these places have beautiful architecture and access to water, whether rivers, ponds, or the ocean.”

Davis believes that zoning ordinances through the state make it difficult to recreate livable places, or to enhance existing centers with sensitive development. “Many of our older urban communities have the bones of a livable, walk able place, but need targeted reinvestment to come alive again with a mix of uses and housing,” he says.

“The state and our cities and towns need to continue to work together to make sure local zoning allows and encourages center development, finds ways to prioritize funding and other supports for these areas, and makes sure that we are planning physically and financially for inclusive and accessible places,” adds Davis.

Davis is seeking public input to make Rhode Island’s communities more livable. “We are currently working on a planning campaign called RhodeMap RI, and need feedback on ideas for growing Rhode Island’s economy and providing for healthy homes and great communities.”

“It’s All in Our Backyard”

“The one surprise in the AARP report is that health care was not a major concern,” says President and CEO Neil Steinberg, of the Rhode Island Foundation, the state’s largest and most comprehensive funder of nonprofit organizations. “We hear about it all the time. In fact, access to quality, affordable health care is one of our strategic priorities,” he says.

“Almost everyone probably can agree on what makes a livable community. They have vibrant arts and culture, concern for children and families, economic opportunity for all, a great educational system, a sound environment, quality health care, housing that doesn’t break the bank and programs that meet basic human needs,” states Steinberg..

“The fact that we do have livable communities is what keeps Rhode Islanders here generation after generation,” says Steinberg, noting that the state’s small size gives its residents a “statewide feeling of connectedness.”

“This sense of belonging may be the most important factor in defining a livable community,” adds Steinberg.

The Rhode Island Foundation which awarded more than $ 31 million in grants last year to help nonprofits tackle critical issues in the state, has implemented a very visible public awareness campaign that reminds people that the Ocean State is a special, very livable place, notes Steinberg. “It’s All in Our Backyard” is about pride of place. It is an effort to help Rhode Islanders connect with our state’s rich resources, he says.

“There are plenty of success stories right here,” Steinberg says, noting that Rhode Island has “global industry and cutting-edge innovation, thriving entrepreneurship and world-class universities, breathtaking landscapes and a major arts scene.”

Steinberg urges, “Let’s celebrate Rhode Island as the vibrant, stimulating place where we work and live.”

It’s a Mixed Bag

AARP Rhode Island State Director Kathleen S. Connell observes that neighborhoods widely differ in the state’s 39 towns and cities, and within larger cities. “That said, a fair assessment would be that there are examples of great strides toward more livable communities as well as places in Rhode Island that are in a state of neglect.”

“The good news is that where improvements are being made today the process is much different when it was a decade ago as far as taking into consideration the interests of a broader range of stakeholders,” Connell adds.

Connell says that “many of the state’s older neighborhoods qualify as “livable” insofar as they are blessed with open space, sidewalks, are near parks and bike paths and feature transportation infrastructure that is designed with consideration for all types of users and people of all abilities.” Many planners and members of zoning boards understand the concept of livable communities and work hard to maintain and expand livable features,” she notes.

“But as the AARP survey revealed, livable also [also] means good schools, responsive local government, safety, convenient public transportation and affordable housing,” adds Connell, noting that there are still “parts of the state where these things have yet to come together that can be improved and communities made more livable.”

Connell warns that making a community livable should not be just to benefit the older population. “It’s really about people of all ages who want to live comfortable, healthy and environmentally responsible lives,” she says, detailing examples that include more public, park-like space in a retail/business district. These are assets for Rhode Islanders of all ages.

“A greener environment can enhance the business climate and local economy and works for all citizens on that level, too,” states Connell. Bike paths benefit all age groups and curb cuts benefit young moms with baby strollers as much as they are helpful to folks who get around with the aide of walkers,” she says.

The AARP study’s findings show that both young and old gravitate to livable communities. These localities allow persons to be more active, stay fit, even connected, allowing aging boomers and seniors to live independently at home. Rhode Islander’s might just think about The Rhode Island Foundation’s message, “It’s All in Our Backyard.” While we have a little ways to go to be a completely livable state, we’re closer to that goal than some naysayers believe.
The full report “What is Livable? Community Preferences of Older Adults” can be found at http://www.aarp.org/research/ppi/liv-com2/policy/Other/articles/what-is-livable-AARP-ppi-liv-com.

For more information about the Rhode Island Foundation’s “It’s All in Our Backyard,” go to http://www.ourbackyardri.com.

For details about RhodeMap RI, and to take the State’s surveys on housing and economic development, go to http://www.rhodemapri.org/rhodemap-virtual-open-house.

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

Meals on Wheels Should Be Expanded

 Published in Pawtucket Times, October 25, 2013

            A warm, nutritious meal combined with social interaction can go a long way to putting the brakes to a state’s spiraling Medicaid costs.  According to new study findings detailed in this months issue of Health Affairs by Brown University public health researchers, expanding programs like Meals on Wheels, would save 26 of 48 states money in their Medicaid programs, just by allowing a person to stay in their own homes. 

            Kali Thomas, Assistant Professor of Research in the Brown University School of Public Health, says that if every U.S. state in the lower 48 expanded the number of seniors receiving meals by just 1 percent, 1,722 more Medicaid recipients avoid living in a nursing facility and most states would experience a net annual savings from implementing the expansion.

Put the Brakes to Medicaid Costs

            According to the study’s findings, Medicaid cost savings would be different in every state.  For instance, Pennsylvania would see the greatest net savings – $5.7 million – as Medicaid costs for nursing facility care decrease more than costs rose for delivering the additional meals.  Meanwhile, Florida would see a net cost of nearly $11.5 million instead. Overall, 26 states would stand to see a net savings according to the Brown University Public Health analysis, while 22 would end up spending more.

            Every state would enable more seniors, who could live independently except for meals, to remain in their homes regardless of whether they are on Medicaid.

            Thomas, the study’s lead author, believes the study’s findings can provide guidance for state lawmakers and state policymakers as they hammer out budget funding for home-delivered meals programs, which are conducted under the Older Americans Act.

            “We wanted to provide a roadmap for people,” Thomas said.

             To calculate Medicaid savings, Thomas and co-author Vincent Mor, Brown’s Florence Pirce Grant Professor of Community Health, examined data, including how many seniors in each state receive home-delivered meals and how much it costs each state to provide those meals. She and Mor also took a look at nursing facility and Medicaid data to estimate the number of seniors that Medicaid maintains in nursing facilities who are “low-care,” meaning they may have the functional capabilities to live at home. Finally they looked at the per diem Medicaid pays in each state for seniors to live in nursing facilities.

 Keeping Seniors at Home

             The study findings allowed them to estimate the incremental cost of providing meals to 1 percent more seniors in each state, the number of additional seniors on Medicaid who would no longer need to live in nursing facilities, and how much less Medicaid would have to pick up for the higher level of care in each state.

            The researchers found that the 1 percent expansion nationwide would bring meals to 392,594 more seniors at a cost of more than $117 million. Because 1,722 seniors would no longer have to live in costly nursing facilities paid for by Medicaid, total program savings would total $109 million.

            The reason why the study’s findings indicate that additional food delivery costs outstrip Medicaid savings nationwide, even though most states would save money on a net basis, is that in some very large states with relatively few low-care seniors or relatively low Medicaid per diems, food costs outweighed the resulting Medicaid savings on a relatively large scale.

            “In states like California and Florida where a 1-percent increase in the 65-plus population is a lot of people, it will cost those states a lot more to feed them,” Thomas said.

            But, as she and Mor wrote in Health Affairs, “Our analyses suggest that 26 states with high Medicaid nursing home per diem reimbursement rates, a large proportion of low-care [nursing home residents on Medicaid], and a relatively small population of older adults, could save money.”

            Thomas said states projected to lose money can opt to focus their efforts in ways that are more precise than an across-the-board expansion.

            “We’re not proposing that all states simply increase the proportion of age 65 plus receiving meals by 1 percent,” she said. “But if they were to target these vulnerable people who are at risk for nursing home placement they would likely see more savings. This is a program that has the potential to save states a lot of money if it’s done correctly.”

            Policymakers should consider not only the fiscal implications of providing home-delivered meals, which the study quantifies, but also the impact on individual seniors, said Thomas, who has seen the benefits anecdotally as a Meals on Wheels volunteer in both Florida and Rhode Island.

            Thomas’s research, detailed in this month’s issue of Health Affairs, which was completed last December, is featured in AARP Rhode Island’s award-winning documentary Hungry in the West End. Creator and director John Martin of the AARP

             Rhode Island state office screened the documentary in August at the Meals on Wheels Association of America National Conference in Boston. You can watch Hungry in the West End online at www.aarp.org/hungry.

             Although the quality of life argument is easy to see, other researchers, like Thomas, are closely looking at how the Meals on Wheels program can lower Medicaid costs.

             Based on a study by the Washington, D.C. based Center for Effective Government released in April 2013, every dollar invested in Meals on Wheels today could save taxpayers up to $50 in Medicaid costs down the road.

 Other Benefits of Meals on Wheels  

             Ellie Hollander, President and CEO of the Meals on Wheels Association of America, observes that both Brown University and the Center for Effective Government studies specifically focused on Medicaid savings attributable to nursing homes, but do not take into consideration significant savings that would be realized through reduced Medicare costs as well, through fewer visits to physicians and the emergency room and less hospitalization or reduced readmissions.

             Hollander says, “We have long known that the value of Meals on Wheels goes beyond the social and moral imperative of helping to address the epidemic of senior hunger in America.  “The friendly visit and a safety check are a lifeline enabling seniors to live more independently and healthy in their own homes, which in turn avoids far more costly health care alternatives often paid through Medicare and Medicaid,” she says.

             “The Brown University research proves what our work has long suggested to us: the Home Delivered Meals Program not only makes a positive impact for the senior, it is a good investment for the state as well,” says Executive Director Heather Amaral, Meals on Wheels of RI.

            Another study is in the works to support Thomas’ efforts to closely look at the impact of nutritious home delivered meals.  According to Hollander, a $350,000 grant from the AARP Foundation and the Meals on Wheels Association announced on Oct. 6 will enable Thomas to begin her randomized controlled trial of 600 seniors representing a cross-section of rural, urban, low income and minority populations across the country and a majority of the grant will be used to feed these seniors.            

            In this upcoming study, 200 seniors will receive meals daily, 200 more will receive a delivery of frozen meals once a week and then another 200 will continue on the waiting list as before as a control group. The study will compare quality of life, isolation, and health care utilization among individuals before and after they begin receiving meals and across the three groups.

             Holland says, “Through our generous grant from AARP Foundation, and with Dr. Thomas and Brown University’s help, we will seek to monetize the value add of the “more than a meal” component of Meals on Wheels.”

A Call for Support

            On AARP.org, Kathleen S. Connell, Rhode Island AARP State Director, calls on state lawmakers to take a very hard look at how they fund the state’s Meals on Wheels program.  Connell urges Congress not to put the Meals on Wheels program on the budgetary chopping block as a way to chop the huge federal budget deficit.

            Connell says that “Leaders need to be reminded that Meals on Wheels recipients aren’t unemployed workers waiting to return to jobs that will accompany an economic recovery. They are older retirees living on limited fixed incomes. With the cost of prescription medicines, healthcare and utilities going up, they sometimes can’t afford to eat. Many commonly sacrifice on food because of money worries – real or feared.”

            Connell notes, “Meals on Wheels is a big deal [to seniors]. No one should take it for granted.”

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

 

 

 

Critics of Chained CPI Call It a “Flawed Policy”

 Published in the Pawtucket Times, July 5, 2013

            With President Barack Obama’s fiscal blueprint unveiled almost three months ago, on April 10, 2013, that included a chained consumer price index (CPI) for the purpose of calculating Social Security cost-of-living adjustments (COLAs), Rhode Island aging advocates go on the offensive opposing the suggested way as to how the federal government would calculate inflation.

             In June 12, 2013, Rhode Island AARP State Director, Kathleen S. Connell, a former secretary of state and one-time teacher, and State President Alan Neville, of Cumberland, along with AARP staff and volunteers from every other state in the nation, traveled to Inside the Beltway to Capitol Hill, on June 12, 2013, to urge Congress to just say “No” to a tying a chained CPI to Social Security.

             Continuing to protest, early this week Connell, Senator Whitehouse and Congressman Langevin and Cicilline, joined over 150 people who voiced strong concerns over Congress’s consideration of a chained CPI.  The Rhode Island Alliance of Retired Americans, the organizer of Tuesday’s protest, called it a “flawed policy,” charged that “switching to a chained CPI would compound benefit reductions dramatically over time, resulting in an annual benefit cuts.” 

            AARP Rhode Island is also planning to host “You’ve Earned a Say” discussions at seniors centers across the state this summer and into the fall to get its membership to rally against changing how Social Security cost of living adjustments are calculated.

 

Critics Take Aim at Chained CPIs

             President Obama’s push in his proposed budget request to rein in Social Security costs (a concession to GOP leadership), through the use of the chained CPI, pushed liberal Democratic lawmakers, including Rep. David Cicilline, representing Rhode Island’s 1st Congressional District and Senator Sheldon Whitehouse, to strongly oppose President Obama or any Congressional efforts to put Social Security on the chopping block to lower the nation’s federal deficit, through changing the way COLAs are calculated.

            Rather than tinkering with the CPI linked to Social Security to rein in the nation’s huge federal deficient, Rep. Cicilline called for reforming the nation’s tax code by ending subsidies for “Big Oil,” along with “making responsible target spending cuts,” to slash the nation’s huge federal deficit

 

            Referring to the Social Security’s 2012 Annual Report in April (see my June 1, 2012 Commentary in the Pawtucket Times) , Sen. Whitehouse stated that Social Security is fully solvent for the next 20 years and has not contributed to the nation’s budget deficit and has no place in the debate over federal spending. 

             Senator Whitehouse called it “a [Social Security] benefit cut disguised behind technical jargon.”  The Senator and other critics argue that the current CPI shortchanges older persons by placing too much emphasis on products that these individuals are less likely to buy, like “smart phones” and “computers.”  He noted that in 2010 and 2011, Social Security beneficiaries did not receive a COLA, even though prices for food and beverages, medical care, gasoline and fuel oil increased.

             According to the Washington, D.C.-based, National Committee to Preserve Social Security and Medicare (NCPSSM), the Obama Administration sees this [chained CPI] switch as just “a technical adjustment.” Aging group warn that using the chained CPI will substantially reduce the Social Security benefits of current and future beneficiaries.  “If it is adopted, a typical 65 year-old would see an immediate decrease of about $130 per year in Social Security benefits.  At age 95, the same senior would face a 9.2 percent reduction—almost $1,400 per year,” notes NCPSSM.

             While all beneficiaries will feel the impact of this change, its effect will be greatest on those who draw benefits at earlier ages (e.g., military retirees, disabled veterans and workers) and those who live the longest, says NCPSSM, especially “women who have outlived their other sources of income, have depleted their assets, and rely on Social Security as their only lifeline to financial stability.”

 What’s the Impact???

             Washington-DC-based, AARP, representing 40 million members, has rolled out an educational campaign, to put the face who loses most if changes are made in how COLAs are calculated. 

 

              Fact Sheets, placed on AARP’s heavily traveled website (http://www.aarp.org/politics-society/advocacy/info-04-2012/youve-earned-a-say.html), tells how a federal policy shift would impact specific demographic groups in their pocketbook.

             Retired women can least afford using the chained CPI calculation because they earn less on average than men (that is $4,000), are more likely to have a part-time job and have gaps in their employment due to leaving the workforce to take care of their children.  With women living longer the chained CPI would slash their benefits more with every year they live.  Older women also rely on their Social Security Pension checks because they are less likely to have other sources of retirement income, this check even keeping 38 percent of them out of poverty compared to 32 percent of older men, the says the AARP fact sheets.

             AARP’s fact sheets, also details the impact on older disabled Americans, noting that 37 percent are dependent on Social Security benefits for nearly all their family income, that is around $13,560 annually.  Many begin getting Social Security checks at a young age.  For instance, a 35-year-old disabled worker who receives average disability benefits would see his or her benefits reduced each year by $886 at 65 and $1,301 at 80.   Finally, Social Security keeps about 40 percent of people with disabilities age 18 and over and their families out of poverty.  Cutbacks in benefits due to tying the chained CPI to the Social Security program would force the persons already living on a very tight budget impacted by rising drug costs, increased utilities and health care expenses to cut back on vital needs.

             Finally, one of AARP’s fact sheets charge that older veterans would be financially slammed, sort of a double whammy.  With almost 1.5 million veterans living below the poverty level, each dollar cut, like older person’s who are disabled, will get hit hard in their pocket book as the years roll by.  Because a chained CPI would cut both Social Security and Veterans’ benefits, this group gets the budget ax thrown at them twice. “A veteran who’s 65 today would have veterans benefits reduced annually by $1,029 and Social Security benefits by $1,422 at 95, when benefits are needed the most,” states the fact sheet.

 Congressional Fight Looming

             Rhode Island’s Senator’s Jack Reed and Sheldon Whitehouse have signed on as co-sponsors of SR 15, with over a dozen Senators, a Resolution Rejecting the chained CPI expressing “the sense of Congress that the chained CPI should not be used to calculate cost of living adjustments for Social Security and Veterans benefits.”

             Meanwhile, in the House of Representatives, a resolution, HR 34, was introduced by Rep. Cicilline, cosponsored by Rep. James Langevin along with 111 other Democrats, also opposing President Obama and GOP attempts to rein in the Social Security budget through the use of a chained CPI calculation.

             With nonbinding resolutions expressing opposition to the use of a chained CPI index now introduced in both chambers of Congress, union and aging groups are urging rallying support for passage.

            AARP’s Kathleen S. Connell and her colleagues around the nation are gearing up to send a message loud and clear, once and for all to Congress.  Simply put, Connell says:  “Chained CPI is not only harmful and illogical; it is also out-of-place in the discussion of deficit reduction.  As a self-financed program providing earned benefits, Social Security has not caused the deficit—and it should not be turned into an ATM for politicians trying to address it.  We deserve a separate national conversation about how to protect Social Security for today’s seniors and responsibly strengthen it for our children and grandchildren.”

            Congress might well choose to tread lightly on giving the thumbs up to using a chained CPI in calculating Social Security Colas. The anticipated fiscal impact (detailed by AARP and aging group critics, along with the Rhode Island Congressional delegation) resulting from this federal policy change will hit the nation’s elderly right where it hurts, the most, in their wallets.  Increased bipartisan efforts can find better solutions to trimming the nation’s huge federal deficit and improving the fiscal viability of the nation’s Social Security Program.

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