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Public Policy & Aging E-Newsletter Volume 3, Number 1, January 2009 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.
I. WHAT’S HAPPENING IN WASHINGTON? A. Recognition of Excellence in Aging Research: The Senate Special
Committee on Aging released an official
Committee report describing federally-funded aging-related research
in fields as diverse as biomedical sciences, housing, and environmental
protection. Such research helps inform Congress during the development
of public policies that help older Americans lead healthier and
more productive lives. Twenty-seven agencies, ranging from the National
Institutes of Health and the Department of Veterans Affairs to the
Environmental Protection Agency and NASA, submitted over two hundred
research projects to be included in this report. C. Immigration and Social Security: A report released by the Center on Budget and Policy Priorities explores the impact of immigration on Social Security revenues and spending. Key findings include: increases in immigration tend to improve Social Security's financial status, and decreases in immigration tend to worsen it; more immigration would likely eliminate only a small portion of Social Security's long-term shortfall; and the impact of immigration on Social Security's finances is modest and should not be a major factor in setting either immigration or Social Security policy. II. WHAT’S HAPPENING AROUND THE COUNTRY? A. The Economic Crisis and Its Impact on State Aging Programs: The National Association of State Units on Aging (NASUA) released a report in December that describes the impact of the economic downturn on the aging services coordinated by State Units on Aging (SUAs). The report reveals that although nearly 85% of states are receiving more requests for transportation and home-delivered meals, and 62% are experiencing more requests for home-heating assistance, 70% of states anticipate necessary cuts in programs for older adults in 2009. B. Evaluation of the Integrated Care Program: The Center for Health
Care Strategies released a report
on its Integrated Care Program (ICP), a two-year initiative that
supported five states'-Florida, Minnesota, New Mexico, New York,
and Washington-efforts to integrate the administration, delivery,
and financing of services for dual eligible beneficiaries. This
evaluation provides a comprehensive view of the progress states
have made in exploring models for integration as well as the challenges
that remain. It describes the five states' experiences and progress
in developing integrated care models, and outlines key considerations
for states interested in pursuing integration for dual eligibles. C. State Leadership for Older Workers: Comparisons of State Workforce Demographics Trends for Adults Aged 55+: An executive summary released by the Boston College Sloan Center on Aging and Work juxtaposes the realities of the aging of the population with the economic challenges state leaders face. This report notes that the variation in states' demographic and economic situations will ensure that the aging of the population will have differential impacts, and therefore encourages state leaders to purposefully assess their individual state's readiness for this demographic shift. III. THIS ISSUE'S MAJOR POLICY STORY: THE HEALTH CARE WORKFORCE One of the principal hallmarks of U.S. geriatrics has been that interdisciplinary teams of health care workers address the problems and attend to the needs presented by patients. The insistence on interdisciplinarity in caring for older patients results in holistic approaches that tend to be cost effective in the long run. Hierarchal models give way to delivery systems in which workers have a sense not only of their own efficacy but of their reliance on the insights and tools of other professionals in improving quality of care. Lessons from geriatrics thus would seem to serve as a model for thinking about health-care reform in this country during President-elect Obama's tenure. To implement the lessons of geriatric health care delivery, however, policymakers must confront sets of interrelated problems. Rates of burn out among dentists, nurses, pharmacists, physicians, social workers, surgeons, and technicians who work primarily with older patients are rising-faster even than among those who work in pediatric units or on cancer wards. Geriatric health care workers on average earn less money and have less prestige than peers who specialize in other domains. No wonder shortages in geriatrics are forecast as the Baby Boomer cohort ages. The articles in this section elaborate the policy challenges of
achieving a better fit between health care professionals and the
patients that they (will) serve. Can we create incentives to recruit
and retain those dedicated to serving aging populations, diverse
demographically and medically? Are there different specialists,
such as oncologists or pulmonary nurses, who can be drawn to the
field (either on a full-time basis or in terms of their evidence-based
practice with older patients) to bolster interdisciplinary teams?
Can we train paraprofessionals to do more caregiving for elders?
The policy choices we make in this area will affect the scope and
cost of health care reform in the U.S. for patients of all ages. --Andy Achenbaum C. Call to Action: Health Reform 2009: Senator Max Baucus recently released a white paper that lays out his vision for both policy and the process in the upcoming health care reform debate. The paper addresses health care coverage, quality, and cost, and identifies family caregivers as an important part of any reform plan. Baucus' plan would provide assistance to individuals, families and caregivers in navigating the long-term care services and supports system. D. Caregiving Training in America and Southern California: Results
of a National Review: The International Longevity Center-USA and
the Schmieding Center for Senior Health and Education released a
report
that presents the findings of a national review of training programs
and curricula for direct care workers. Although the review is national
in scope, special emphasis is placed on Los Angeles and Orange Counties
in Southern California, two of the most diverse and populous areas
in the country. The report reveals that there is no national standard
for training direct care workers, although many consumers assume
these workers are trained. It also outlines best practices and innovations
in training direct care workers and serves as a springboard for
further research. E. The Health Care Delivery System: A Blueprint for Reform: The Center for American Progress and the Institute on Medicine as a Profession released a new major report that offers recommendations and pathways to systematically promote quality, efficiency, patient-centeredness, and other salient characteristics of a high-performing health system. It proposes policies that the next administration and Congress could enact over the next five years to improve the U.S. health care system in different areas: infrastructure, organization, quality, payment reform, patient activation, and population health. Of specific interest, chapter 2 of the report, titled "Workers, Tools, and Knowledge," identifies the most vital element of a high-performing health care system as a highly trained, balanced, and motivated workforce. It therefore makes recommendations for improving and growing the nursing and geriatric care workforces and building an expanded primary care workforce. For a summary of the report's recommendations, click here. IV. WORTH NOTING A. Rethinking Age and Aging: This Population Bulletin illustrates how to use new measures of population aging that take into account changes in longevity over time and place. First, it discusses the history of life expectancy change within the last 150 years. Second, it introduces a new way to compare people who live in periods and places where life expectancies differ. Third, it develops alternative definitions of median age, the elderly population, and old-age dependency ratios. Finally, the report concludes by suggesting that policy makers can use these new measures of population aging to develop and reauthorize the most modern, fair, and effective policies and government programs. B. CMS Issues Rating System for Nursing Home Quality: The Centers
for Medicare & Medicaid Services (CMS) announced its launch
of a ground-breaking "five-star" ranking system of America's
nursing homes. This tool presents detailed information about every
Medicare- and Medicaid-certified nursing home in the country. The
ratings are posted on the agency's Nursing
Home Compare Web site. C. Safe Quality Care for Seniors: A ballot
initiative passed on November 4 in Washington (Initiative 1029)
that requires increased training of workers who provide long-term
care services. Under the new law, home and community-based long-term
care workers must complete 75 hours of training to receive state
certification. They will need to pass an exam to be certified as
home care aides, and background checks will be required for all
levels of care. The measure was originally intended for action in
the legislature, but when lawmakers failed to act, supporters of
the initiative succeeded in getting it on the ballot. V. WHAT'S HAPPENING ABROAD? A. Funding Long-Term Care: The Building Blocks of Reform: This
report,
released by the International Longevity Centre-UK, addresses the
widespread agreement that the UK long-term care funding system requires
significant reform. It sets out the core tasks required of the UK
long-term care funding system; reviews the context for reform, identifying
the key issues that must be considered when evaluating different
models of long-term care funding; identifies the different basic
models of long-term care funding available; and explores how these
different models of long-term care funding could be integrated and
combined. B. Home Care in Europe: The World Health Organization Europe released
a new report
that addresses how epidemiological, social, and cultural changes
in European countries require a different approach to health and
social sector policy and services. The report explains why health
and social services should provide high-quality and targeted home
care for disabled and older people. It provides evidence for the
effectiveness of home care, shows how it can be improved and explains
the need to ensure equitable access. This report also explores the
varied care contexts in different countries and reveals how to educate
professionals and the public about these issues. C. International Data Base (IDB): The U.S. Census Bureau has revised
its population
estimates and projections for 19 countries, including Bangladesh,
Bermuda, Bolivia, Ecuador, North Korea, Kosovo, Mauritania, Nauru,
Nepal, Niger, Palau, Puerto Rico, Saint Vincent and the Grenadines,
Senegal, Serbia, Seychelles, Turkey, Turkmenistan, and the United
States. The population estimates and projections for each country
include summary data, population pyramids and access to additional
data. VI. PERSPECTIVES ON POLICY: ROB HUDSON, EDITOR, PP&AR Taxes, Tax Breaks, and the Elderly Much ink and many pixels have been shed and shown about public sector expenditures on behalf of older people. Less attention has been paid to the place and role of older people as taxpayers. The current issue of Public Policy & Aging Report examines tax provisions at the federal, state, and local levels that differentially affect younger and older taxpayers. These include deductions, exemptions, deferrals, circuit breakers, and other provisions, most of which benefit older adults. Each state has at least one such tax provision. Over half the states exempt Social Security income from taxes; half exempt some or all private pension income; and two-thirds exempt some or all government pension income. For nearly 50 years, the federal government never taxed Social Security income; now many middle-income and all high-income seniors have that income partially taxed. These provisions raise important questions. Do the original justifications for such exemptions still hold? Do these provisions reflect coherent overall policy? Thus, are such provisions designed to aid lower-income elders or, in contrast, are they designed to keep or attract higher income retirees looking to live in places where taxes are low? And, if we need to raise taxes to pay for exploding government expenditures - some age-related, some not - what should they look like and who will they impact? More progressive income taxes would generate income from the wealthy (some old, some not), but a national consumption tax would heavily impact those who consume most of their income (lots of old, many others). With articles by economists Karen Conway and Jonathan Rork, Urban
Institute Fellow Rudolph Penner, Center on Budget and Policy Priorities
analyst Liz McNichol, and AARP Policy Institute scholars John Gist
and David Baer, this issue of PP&AR provides a treasure trove
of data and opinions directed to this taxing question. To purchase the current issue of PP&AR, or to subscribe, click
here,
and then click on "NAAS Publications." The Public Policy & Aging E-Newsletter is a free bimonthly email publication. If you would like to subscribe, please click here and type “Subscribe” in the subject line. If you would like to unsubscribe to this newsletter, please click here and type “Unsubscribe” in the subject line. Newsletter Editors: Sarah Frey and Greg O'Neill, National Academy
on an Aging Society; Andy Achenbaum, University of Houston.
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