Public Policy & Aging E-Newsletter

Volume 3, Number 3, May 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. The Edward M. Kennedy Serve America Act: In April, President Obama signed into law the Edward M. Kennedy Serve America Act (H.R. 1388), which expands national and community service opportunities for Americans of all ages. The act specifically benefits Americans aged 55 and older in several ways: it establishes Encore Fellowships that allow older Americans to hold one-year paid management or leadership positions in nonprofit organizations; it more than triples the number of AmeriCorps positions, and targets 10 percent of AmeriCorps funds to organizations that engage adults age 55 and older; and it creates Silver Scholarships that provide a $1,000-transferable to children and grandchildren-higher education scholarship to older volunteers who contribute at least 350 hours of service per year. Encore.org features a quick summary of the legislation as well as additional resources related to the legislation.

B. Chronic Care: A Call to Action for Health Reform: The latest in AARP's series of "Beyond 50" reports, this research report addresses the rapid rise in the number and proportion of individuals living with one or more chronic illnesses, and describes how patients and caregivers experience the health care system and the challenges of coordinating care. Survey findings suggest opportunities for improvement in care coordination and chronic care management, especially during transitions. The report's key recommendations include: engaging patients with chronic conditions in their own care; supporting family caregivers as partners with professionals; investing in health information technology; ensuring an adequate workforce; and increasing medication affordability.

C. Generations United Public Policy Agenda for the 111th Congress: Generations United just released its legislative priorities for the current Congress. This document urges Congress to: give priority to communities that commit to building facilities that serve both young and old in economic recovery efforts; ensure policies are in place to guarantee that grandfamilies benefit from upcoming legislation; and promote intergenerational civic engagement and multigenerational activities.

II. WHAT’S HAPPENING AROUND THE COUNTRY?

A. Social Security State Quick Fact Sheets: 2008: AARP recently released one-page fact sheets that provide an overview of Social Security for each of the 50 states and the District of Columbia. Each state's fact sheet includes: demographic information for its Social Security beneficiary population; estimates of average personal income and Social Security income; a description of Social Security benefits; and identification of Social Security's role in lifting retirees out of poverty.

B. Across the States 2009: Profiles of Long-Term Care and Independent Living: AARP recently released a new edition of its state and long-term care reference report. This report presents the most up-to-date comparable state-level and national data for more than 140 indicators. It includes an overview of key findings and trends, maps and graphs, and individual profiles of long-term services and supports for each state, the District of Columbia, Puerto Rico, and the Virgin Islands.

C. Medicare and Medicaid Participating Facilities: CMS Needs to Reexamine Its Approach for Funding State Oversight of Health Care Facilities: A new report from the Government Accountability Office (GAO) evaluates the joint Centers for Medicare and Medicaid Services (CMS)-state periodic surveys of the tens of thousands of health care facilities participating in Medicare and Medicaid. The report assesses survey funding, state workloads, and federal oversight of states' use of funds since 2000 to determine if federal funding has kept pace with the changing workload. The evidence is mixed on whether federal funding has kept pace with the changing workload.

III. THIS ISSUE'S MAJOR POLICY STORY: ENTITLEMENT REFORM

Historians typically leave forecasting to economists; we are content to be Monday-morning quarterbacks. But I am sorely tempted to introduce the articles and briefs in this Section as the opening of an attempt to re-frame and to re-form the shape and scope of entitlements for U.S. citizens in general and for older Americans in particular.

Well into adulthood, this Baby Boomer understood entitlement reform to mean the liberalization of Social Security, disability, and health care benefits--typically in an incremental manner. Over time, and especially during and after Ronald Reagan's presidency, the historical vector changed: Neo-conservatives cut the rate of growth of benefits and proposed eliminating some entitlements altogether. They made their case for entitlement reform on new historical circumstances, ranging from fiscal pressures to appeals to intergenerational equity. We now are probably in the midst of another watershed. Policymakers in and outside of the Capitol are seeking not so much a "middle way" as a reworking of traditional values in an aging society. They seek to build on our collective desire to address real needs to be found in the "public square" while recognizing our obligation to attend to other "e" policies--the economy, energy, education. Since we all have a stake in the outcome, we should read what follows for what is said, what is taken for granted, and what surely will be contested.

--Andy Achenbaum


A. It's Not Easy Being Gray: The New Rules of Retirement: This Urban Institute brief summarizes wide-ranging retirement issues and explores how public policies might adapt to an aging population. Retirement topics include: strengthening Social Security and Medicare; controlling health care spending; and helping older adults remain in the workforce. This brief results from an Urban Institute-convened roundtable discussion of experts in retirement, aging, health, and long-term care policy. To listen to an audio recording of the discussion, click here.

B. Taking the Long View: Investing in Medicaid Home and Community-Based Services is Cost-Effective: This AARP research report argues that targeting Medicaid home and community-based services (HCBS) for budget cuts may be shortsighted because the costs savings from HCBS manifest in the long run. The report cites research that reveals that states that invest in HCBS programs experience slower Medicaid spending growth and serve more beneficiaries with available dollars than states with low HCBS spending. The report recommends that states: achieve a funding balance between institutional services and HCBS; establish effective HCBS infrastructure to transition nursing home residents into community settings; and provide services and supports for family caregivers.

C. Home and Community-Based Services: Public Policies to Improve Access, Costs, and Quality: The Center for Personal Assistance Services (PASC) recently released a report that offers suggestions for improving both state and federal long-term care policy. The report examines issues of access, cost, and quality of Medicaid home and community-based services (HCBS) programs, and summarizes the trends in state Medicaid HCBS programs, target groups, participants, and expenditures. The report identifies the progress states have made in providing Medicaid HCBS, identifies many current problems, and recommends policies to improve access, costs and quality at the federal and state levels.

D. Medicare Matters: There's no Easy Medicare-Only Fix for Health Costs; and Entitlement Reform Means Fixing the Broader Health System: Medicare and Medicaid's Budget Challenges: Two issue briefs released by the Center for American Progress argue that policymakers must couple Medicare and Medicaid reform with system-wide health reform. The first brief, Medicare Matters, points out that if the federal government simply cuts Medicare to reign in health care costs, the result will not be lower costs, but inadequate coverage. Therefore, policymakers must address what is driving Medicare costs: the overall cost of care. The second brief, Entitlement Reform Means Fixing the Broader Health System, suggests measures to decrease overall health care costs: investing in health information technology; conducting and employing comparative effectiveness research; and building payment structures that encourage doctors to prioritize outcomes over volume.

E. The Case Against Intergenerational Accounting: The Accounting Campaign Against Social Security and Medicare: This public policy brief, published by The Levy Economics Institute of Bard College, addresses the proposal of The Federal Accounting Standards Advisory Board (FASAB) to subject the entire federal budget to "intergenerational accounting," which purports to calculate the debt burden that current generations will leave for future generations. The authors argue that intergenerational accounting should play no role in federal government budgeting because the government operates in the public interest, and it is not in the public's best interest for Social Security and Medicare spending to be politically constrained by tax receipts.

IV. WORTH NOTING

A. May is Older Americans Month: Since the first Older Americans Month in 1963, United States citizens have acknowledged the contributions of older persons. It is celebrated across the country with ceremonies, events, fairs, and other activities. Each year the Administration on Aging (AoA) issues a theme for Older Americans Month. This year's theme, "Living Today for a Better Tomorrow," reflects AoA's continued focus on health and prevention efforts. In anticipation of Older Americans Month, the Census Bureau released a fact sheet describing America's 2009 older demographic. For more information on Older Americans Month, click here.

B. LGBT Aging Resources Clearinghouse: The American Society on Aging (ASA) created a LGBT Aging Resources Clearinghouse that holds information related to and resources for lesbian, gay, bisexual, and transgender people aged 50 and older. The site's searchable resources span several categories: education and training; health and mental health; housing and support services; populations and communities; and public policy, advocacy and legal issues. Resources include annotated listings for service providers, community and professional organizations, information sites, reports and articles, and links for ordering DVDs, books and other useful products.

C. Health AGEnda: The John A. Hartford Foundation Blog: The John A. Hartford Foundation launched a new blog, titled Health AGEnda. Health AGEnda encourages policy makers and thought leaders to consider older adults' experiences in the nation's ongoing debate about how to improve the health care system for all Americans.

A. Population Aging and Public Infrastructure: A Literature Review of Impacts in Developed Countries: This Infrastructure Canada study prepared by PricewaterhouseCoopers LLC assesses the impacts of aging demographics on public, engineering, and social infrastructures in developed countries, with special emphasis on the challenges and opportunities faced in Canada. The report's findings reveal that demand for some types of public services and infrastructure will increase, while it will decrease for others. For example, the aging population will necessitate increased health services and safety modifications to public transit and roadways. At the same time, however, an older population will demand less water and fewer educational facilities.

B. Latin America's Aging Challenge: Demographics and Retirement Policy in Brazil, Chile, and Mexico: Available in English, Spanish, and Portuguese, this report from the Center for Strategic and International Studies (CSIS) describes the demographic transformation facing Latin America: that the share of Latin America's population aged 65 or older will triple by mid-century. The report then examines the economic, social, and geopolitical implications of the impending demographic transformation. Finally, the report argues that Latin America has a small but critical window of opportunity to prepare for it by strengthening its retirement systems and improving its living standards.

C. Social Security Financing: Automatic Adjustments to Restore Solvency: This AARP paper describes the automatic mechanisms that 12 countries have adopted to improve Social Security solvency, in place of changing taxes or benefits in an ad hoc manner. The report, analyzing the experiences of these 12 countries, offers useful insights on the potential design features of auto-stabilization mechanisms and what their effects might be if implemented in the United States.

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

The latest issue of Public Policy & Aging Report examines "Livable and Sustainable Communities." It 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.

This issue also features a collection of profiles of innovative approaches to livable and sustainable communities.

To purchase the current issue of PP&AR, or to subscribe, click here, and then click on "NAAS Publications."

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Newsletter Editors: Sarah Frey 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.