Over the next 20 years the proportion of the U.S. population over the age of 60 will dramatically increase as 78 million baby boomers reach retirement age. By 2030, 70 million Americans - twice the number in 2000 - will be 65 and older. At that point older Americans will comprise 20 percent of the U.S. population, representing one in every five Americans.
There will be a similar growth rate in New York State's population. From 2000 to 2030, our age 60 plus population will increase by 65 percent, from 3.2 million to over 5.3 million. Additionally, the State's 85 plus population will increase more dramatically from 315,378 to 555,993, or 76 percent, during this period. This has serious programmatic and funding implications because of the high incidence of multiple chronic conditions and dementia in this oldest segment of the senior population. Half of the 85+ population will suffer from some form of dementia and the 75+ age group is the age group most at risk, as chronic conditions and other health care problems arise, for Medicaid spend down.
These demographic shifts will be accompanied by a corresponding rise in the need and demand for fiscal, health and social supports that are necessary to ensure a sound quality of life for millions of older Americans and to divert older Americans from higher and more costly levels of care. The aging of our nation's population will challenge not only federal entitlement programs, such as Social Security, Medicare and Medicaid, but will substantially impact the demand for home and community-based support services, offered through such programs as the Older Americans Act.
The well-established system of federal, state and local agencies that comprise the Aging Services Network is committed to and, with adequate resources, capable of meeting the service demands of the nation's aging population. This Network is comprised of the federal Administration on Aging, 56 State Units on Aging, 632 Area Agencies on Aging, and thousands of service providers that have delivered aging services in every community across the country for nearly 45 years. In New York, the Network includes NYSOFA, 59 Area Agencies on Aging and approximately 1,200 service providers.
The 111th Congress presents a variety of challenges and opportunities for accomplishing many of our public policy goals on behalf of New York State's seniors. In support of the New York State Aging Services Network, this document details our federal funding and policy priorities for the First Session of the 111th Congress (2009).
Continue Implementation of Older Americans Act (OAA) Amendment of 2006 - The OAA funds critical programs and services to keep seniors healthy and independent, including: nutrition, senior centers, home and community-based services, family caregiver support, protection against abuse and neglect, legal assistance, information and assistance, older worker training and employment, transportation, and disease prevention and health promotion. OAA programs save tax dollars by reducing or delaying premature nursing home placement and medical assistance applications, averting malnutrition and controlling chronic health conditions.
In the fall of 2006, Congress accomplished the number one priority from the 2005 White House Conference on Aging -- reauthorization of the OAA for five years (2007 - 2011). The Older Americans Act Amendments of 2006 (P.L. 109-365) strengthen the role of the Aging Services Network in preparing for the retirement of the baby boomers and steering efforts to build self-sufficient long-term care options for the population as it ages. Core principles that are reflected in the reauthorization include: re-balancing long-term care, increasing consumer choice, developing single-point of entry for all aging services, expanding evidence-based health promotion, and promoting livable communities for all ages. These new responsibilities require new and significantly expanded resources.
In order for the new provisions of the Act to be fully implemented, Congress must act annually to appropriate adequate resources to the Aging Services Network. To accomplish this, we recommend:
Increase funding for Older Americans Act (OAA) programs administered by AoA by at least 12 percent, to allow the OAA to keep pace with projected population growth and increases in inflation.
In FFY 2010, the nation's age 60 plus population eligible for OAA programs will grow by at least 3 percent. Meanwhile, the cost of providing these services will likely increase by over 6 percent. The OAA is a critical part of the nation's long term care system, providing older Americans with much needed services including home care, congregate and home-delivered meals, adult day care, ombudsman, disease prevention and health promotion, elder abuse prevention, care management, legal services, transportation and caregiver support programs.
For years, OAA funding has not kept pace with inflation or the growing population of individuals eligible for services, yet demands by at-risk older adults in need of support services has risen and will continue to rise with the growth in the aging population. The authorization of the National Family Caregiver Support Program in the 2000 amendments and the addition of the principals for "Choice for Independence" and other changes in the 2006 amendments have also created new demands by focusing on services to new populations - grandparents and other relative caregivers, children with severe disabilities, and those with Alzheimer's or other forms of dementia. The need for an inflation adjustment is magnified by the fact that aging programs have had to absorb increases in operating costs over the past several years due to such factors as increases in insurance premiums, gasoline and food prices, as well as being entrusted with new responsibilities without added resources. Additionally, labor costs for many aging programs will continue to rise with phased increases to both the state and federal minimum wages. Many of these added costs have had a negative impact on the Aging Services Network's ability to recruit and retain volunteers that provide critical services such as Ombudsman, health insurance counselors, and drivers in the "Meals on Wheels" program.
Support the role of the Aging Network in transforming the long-term care system by providing at least $50 million for the "Choices for Independence" initiative under Title II for FFY 2010. This funding should increase in increments of at least $25 million in each succeeding year. The "Choices for Independence" initiative that was incorporated into the Older Americans Act with the 2006 amendments supports the development of comprehensive, coordinated systems for providing long-term care in home and community-based settings by:
Provide at least $20 million in funding for the Statewide Legal Assistance Development Program in order to meet the mandates of Title VII, Chapter 4 of the Older Americans Act.
State Units on Aging are required to have a State Legal Assistance Developer to operate a program to ensure the legal rights of older individuals are maintained. While the other Title VII programs -- Long-Term Care Ombudsman and Elder Abuse Prevention -- have received initial funding and increases since 1992, the State Legal Assistance Development Program has never been funded, despite its programmatic authorization. Without funding, states cannot effectively provide technical assistance, training, and other supportive functions to area agencies on aging, legal assistance providers, ombudsmen, and others, and the promise to safeguard our vulnerable elderly from abuse, neglect, and exploitation will not be fulfilled. The economic cost in not providing this funding is the potential for greater costs in public assistance, public housing, Medicaid, and other services.
Allocate resources for demonstration programs authorized in the 2006 Amendments.
The 2006 amendments to the OAA significantly increased the breadth and scope of demonstration programs authorized under Title IV - Activities for Health, Independence and Longevity. Among these are:
Enact legislation to integrate mental health and chemical abuse services into federal programs serving seniors.
NYSOFA supported the inclusion in the OAA reauthorization of demonstration project grants for screening and treatment for mental health and urges that these projects be fully funded. NYSOFA will continue to support legislative initiatives to strengthen mental health and chemical abuse services and outreach, especially using evidence-based protocols and models targeting community service integration, and to require health insurance plans to guarantee parity in coverage and reimbursement for mental and substance abuse disorders and physical health.
Increase funding for Title V - Older American Community Service Employment Program by at least 12 percent, and provide oversight of the U.S. Department of Labor's implementation of the 2006 Amendments.
While legislation to provide phased increases to the federal minimum wage were enacted, Title V funding needs to be increased to accommodate not only increases in the minimum wage at both the state and federal levels but also to increase the total number of positions available for seniors. In addition, Congressional oversight is needed to ensure that congressional intent is reflected in any new rules or guidance issued by the U.S. Department of Labor and that the program's core values, such as community services, are retained.
Low Income Home Energy Assistance Program (LIHEAP) - Maintain LIHEAP funding at $5.1 billion as authorized by the Energy Policy Act of 2005. LIHEAP plays a critical role in helping New York's low-income seniors, families with children, and disabled citizens meet their energy costs. A portion of these funds also go to weatherization services that lower energy costs for recipients due to efforts to make their homes more energy efficient. New York receives about 12.5 percent of regular LIHEAP funds distributed nationwide. In FFY 2009, New York received $537.65 million. In program year 2007-2008, 853,099 New York households received funds to pay for their heating bills under the LIHEAP program. Of this number, 293,488 are households of clients 60 years of age or older. Also, 18,775 of these elderly clients received an additional LIHEAP emergency payment. With rising gas and oil prices, projections of a harsher winter, wars in Iraq and Afghanistan, and increased applications, increased regular and emergency funding is urgently needed.
Medicare Beneficiary Counseling Services - Provide at least $55 million ($1.25 per Medicare beneficiary) for the State Health Insurance Assistance Programs (SHIPs) to provide Medicare information, outreach, counseling and assistance (including Medicare Part D) to Medicare beneficiaries for these activities. Such funds should be set aside under the allocation to the Centers for Medicare and Medicaid Services (CMS). There are nearly 2,860,000 Medicare beneficiaries in New York State. SHIPs are critically needed to assist seniors in understanding the increasing complexity of Medicare benefits, selecting the best plan among an increasing array of choices, including those choices under Part D. The New York SHIP provided one-on-one counseling and assistance to approximately 108,000 individuals in 2008. Hundreds of thousands more Medicare beneficiaries and their caregivers received information through various outreach efforts.
CIVIC ENGAGEMENT: Support full funding of the Serve America Act that expands the opportunities for people to provide service to meet specific national challenges. The measure would:
Fall Prevention - Provide $20.7 million in FFY 2010 for the Centers for Disease Control to fund the Safety of Seniors Act (Public Law 110-202) that was signed into law in April 2008 and would reduce falls among adults. Once funded, the program would include:
Each year, one in three older Americans (65 and older) falls, and 30 percent of falls cause injuries requiring medical treatment. In 2005, nearly 16,000 older adults died from falls, 1.8 million older adults were treated in emergency departments, and 433,000 of these patients were hospitalized. Falls are the leading cause of injury deaths and nonfatal injuries for those 65 and over. The total cost of all senior fall injuries is estimated at $20.2 billion annually and is expected to reach $32.4 billion by 2020. Funding of the Keeping Seniors Safe from Falls Act could prevent a lot of needless suffering of seniors and save health care resources.
SENIOR TRANSPORTATION - Reauthorize the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETY-LU) and enhance funding authorization for the Federal Transit Administration's (FTA) Section 5310 Formula Grant Program, which helps non-profit transportation providers meet the needs of the elderly and persons with disabilities, above the authorized level for FFY 2009 of $133.5 million, and fund the 5311 Rural Formula grant program and the Section 5317 New Freedom Program above the FFY 2009 authorized levels or $537 million and $92.5 million, respectively. Provide at least $35 million nationally for an Economically Sustainable Transportation Program that would build new community focused models for transportation.
National Center for Senior Transportation - Allocate $2 million for the National Center on Senior Transportation (NCST) for FFY 2010 to provide seed grant support that would assist local communities and states in the expansion and provision of transportation services for older adults.
Sedtion 202 Senior Housing - Support an increase in funding for the Section 202 Elderly Housing program to at least $795 million (an increase of $30 million over the FFY 2009 funding level of $765 million), provide at least level funding for Assisted Living Conversion Grants ($25 million for FFY 2008), and increase funding for Service Coordinators to $75 million. Access to affordable housing is a major barrier to keeping seniors in their communities.
Real Choice Systems Change Grants - Increase funding to $20 million ($5 million in FFY 2009) for the Real Choice Systems Change Grants, which are used to enable states and community partners to make effective and enduring improvements in community-integrated services and long-term support systems that allow seniors and persons with disabilities to remain in their homes and communities.
Geriatric Education and Training - Increase funding to $50 million for Title VII Geriatric Education Centers and Training. These funds address a national need to train health care professionals by raising their core competencies in the area of geriatrics. This is a critical issue given the growing senior population. Older Americans account for one third of all hospital stays and half of all days of inpatient hospital care. By 2015, most health care professionals will spend at least half of their time caring for people over the age of 65. Yet only 10 percent of the nation's 125 medical schools require coursework in geriatrics and only three have geriatrics departments.
Social Services Block Grant (SSBG) - Restore the SSBG to its previously authorized funding level of $2.8 billion and continue to provide flexibility by allowing states to transfer up to 10 percent for their Temporary Assistance for Needy Families (TANF) funds to SSBG. In addition to services for families and children, SSBG funds are directed to home-based services for older adults, such as meals on wheels, adult day care and domestic violence counseling. SSBG also funds adult protective services and adult foster care. SSBG offers states the means to fill gaps in critical social services. Funding for the SSBG has been cut by over $1 billion and the authorization level has been reduced twice over the last 13 years. Even with efficient use of SSBG funds and an increasing number of states transferring the maximum allowance of TANF funds, communities still have older adults on waiting lists for many essential supportive services.
Community Services Block Grants (CSBG) - Funding levels for the Community Services Block Grants should be restored to at least the 2005 levels of $4 billion in order to increase affordable housing opportunities. CSBG also funds a range of supportive services to lessen poverty among older adults and to help them live independently in their communities. These flexible dollars build on OAA's core programs to help provide affordable housing, transportation services and/or nutrition assistance.
Lifespan Respite Care Program - Provide the FFY 2010 authorized funding level of $71.1 million for the Lifespan Respite Care Act to expand and enhance respite care services to family caregivers, improve the statewide dissemination and coordination of respite care, and provide, supplement, or improve access and the quality of respite care services to family caregivers. Respite care reduces caregiver burnout that has a direct link to nursing home placement and increased Medicaid costs.
Each of the above programs plays a significant role in supporting and facilitating the independence, health and continuing community involvement of millions of seniors. Every one of these programs has either been unfunded or underfunded.
Program Authorizations: Note - Bills numbers referenced in this document are numbers assigned during the 110th Congress with a few exceptions. New bill numbers will be assigned as bills are reintroduced in the 111th Congress.
Project 2020: Authorize and fund this Aging Services Network initiative that builds on the promise of home and community-based services. Project 2020 has three components:
Based on the NASUA/N4A policy brief, substantial federal funding through the year 2020 would be included in the Project 2020 initiative for grants to the states. All states would be eligible for all grants. Major provisions would include:
According to initial estimates, the program has the potential to reach over 40 million Americans and would reduce federal Medicaid and Medicare costs by approximately $2.7 billion over the first five years of the initial requested investment, resulting in a net savings to the federal government of over $300 million. The program would also generate significant savings for state governments. Financial performance is expected to improve in years five through ten of the program, as all systems reach full scale operations nationally, with the net federal savings over ten years reaching over $1.4 billion.
ELDER JUSTICE ACT Enact legislation to improve protections against elder abuse and neglect. Protecting seniors from abuse, exploitation and neglect is critical to their continued health and independence and is a fundamental responsibility of a just society. NYSOFA supports the Elder Justice Act (S. 795/H.R. 2006 in the 111th), which would create a combined law enforcement and public health approach to study, detect, treat, prosecute and prevent elder abuse, neglect and exploitation. The bill would:
Elder abuse is a growing problem in the United States. The 2004 Survey of Adult Protective Services found an increase of 15.6 percent from 2000 to 2004 in the number of substantiated cases of elder abuse and neglect. In 20 states more than two in five victims, or 42.8 percent, were over the age of 80. Most alleged perpetrators in 2003 were adult children (32.6 percent), or other family members (21.5 percent), while spouses/intimate partners accounted for 11.3 percent of the total cases.
NURSING HOME TRANSPARENCY: Support enactment of the Nursing Home Transparency and Improvement Act (S. 647 in 111th/H.R. 5799). Taxpayers spend more than $75 billion a year on nursing home care. Yet corporate chains--which own more than half of nursing homes -- make huge profits from Medicare and Medicaid without accountability to the government, residents, or families for how they use the money. This bill would:
PATIENT SAFETY: Support the Patient Safety and Abuse Act (S. 631 as reintroduced in 111th Congress/H.R. 3078) that would build on a pilot program allowing states to participate in a state-based abuse and neglect registry system and a database for criminal background checks for direct care workers including fingerprint checks through the FBI fingerprint ID system. The bill would:
BAN ON MANDATORY BINDING ARBITRATION: Support the Fairness in Nursing Home Arbitration Act (S. 2838/H.R. 1237 as reintroduced in the 111th Congress) that would ban the use of mandatory arbitration clauses in nursing home contracts. The clauses require that people seeking to enter a nursing home and their family agree to waive their right to take disputes regarding care at the facility to court and must settle them through arbitration. The goal of the bill is to protect residents and families from being forced to make a critical decision about their legal rights during the stressful and emotional process of admission into a nursing facility, at which time families are focused solely on finding their loved one the best possible care and not on the legal technicalities of arbitration.
MISSING OLDER AMERICANS: Support the National Silver Alert Act of 2009 (H.R. 632 as reintroduced in the 111th Congress) that would establish a national Silver Alert network within the Department of Justice to assist regional and local search efforts for missing seniors in coordination with states, local governments and law enforcement agencies. It also would assist states in establishing Silver Alert systems and provide grants to public agencies and nonprofit organizations to maintain an information clearinghouse and database on missing older adults.
Also, support the Missing Alzheimer's Disease Patient Alert Act (H.R. 908) that amends the Violent Crime Control and Law Enforcement Act of 1994 to reauthorize the Missing Alzheimer's Disease Patient Alert Program. The bill directs the Attorney General, through the Bureau of Justice Assistance and in consultation with the Secretary of Health and Human Services, to award competitive grants to nonprofit organizations to assist such organizations in paying for the costs of planning, designing, establishing, and operating locally based, proactive programs to protect and locate missing patients with Alzheimer's disease and related dementias and other missing elderly individuals. The legislation authorizes appropriations of $5 million for FFY 2010 through 2016.
CLASS ACT - Support the Community Living Assistance Services and Supports (CLASS Act - S. 697/H.R. 1721) that would create a nationwide voluntary insurance program to help people get coverage for long-term services and supports. Financed through voluntary payroll deductions of about $30 per month, with an option to opt out for those who choose not to participate, this legislation will help remove barriers to independence by providing a $50-$100 a day cash benefit to individuals who are unable to perform activities of daily living.
Medicare Part D - Strengthen Medicare Part D prescription drug benefits by improving access to the Low-Income Subsidy (LIS - Extra Help) program. Much can be done to strengthen the Medicare Part D program, which provides valuable extra help under the LIS program. LIS eligibles have low or no copayments, deductibles and premiums, as well as coverage in the "donut hole." Unfortunately, an estimated 75 percent of the over 4 million beneficiaries still without any drug coverage are LIS eligible.
One of the Aging Services Networks priorities is to find and enroll LIS eligibles. To this end, NYSOFA's legislative recommendations include:
PREVENTIVE HEALTH - Support the Shingles Prevention Act (H.R. 1038) that provides coverage for the shingles vaccine (Zostavax) under Medicare Part B rather than under Medicare Part D. This change should obviate problems that seniors are having receiving the shingles vaccination as well as correct problems with reimbursement under Part D.
Medicare Pilot Program: Support the Independence at Home Act (S. 3613, H.R. 7114) that would create a three-year Medicare demonstration project in 26 states using a patient-centered health care delivery model to ensure that Medicare beneficiaries with multiple chronic health conditions can remain independent for as long as possible in a comfortable environment. Eligible beneficiaries would include those who have functional impairments, two or more chronic illnesses and recent use of other health services. Under the bill, participating physicians or nurse practitioners would collaborate with beneficiaries to develop a comprehensive care plan. The legislation also includes minimum performance standards for health outcomes and would measure the satisfaction level of beneficiaries, caregivers and providers. The bill would require providers to demonstrate savings of at least 5 percent annually compared to the cost of serving non-participating Medicare beneficiaries with chronic health problems. Providers would be able to keep 80 percent of the savings as an incentive for participation.
Medicaid Home and Community-Based Care: Support the Empowered at Home Act (S. 3327/H.R. 7212) that is designed to improve states' ability to provide Medicaid home and community-based services (HCBS) to eligible beneficiaries. The bill would:
In addition, the House bill would increase the federal Medicaid match (FMAP) by five percent for HCBS State Plan Amendments services provided under the DRA. It also would exclude from the asset/resource eligibility criteria for Medicaid HCBS services an amount equivalent to the cost of six months of nursing facility services.
Geriatric Care: Support Caring for an Aging America (S. 2708/H.R. 6337) that encourages geriatric and gerontology training and services by:
Also, support the Retooling the Health Care Workforce for an Aging American Act (reintroduced in the 111th Congress as S. 245 and H.R. 468) that would expand education and training opportunities in geriatrics and long-term care for licensed health professionals, direct care workers and family caregivers by amending the Public Health Service Act, the Workforce Investment Act, the Older Americans, and the Social Security Act. The bill also addresses the training and support of personal and home care aides, as well as training and support for the estimated 44 million family caregivers providing increasingly complex care to frail and elderly loved ones who choose to remain in their own homes. With regard to the Older Americans Act, the bill establishes a National Resource Center on Students, Volunteers and Seniors to develop partnerships with aging services network providers to give high school and college students in social work, nursing, gerontology, dental hygiene, music therapy, nutrition and other disciplines the opportunity to work with low-income seniors. In addition it provides for best practices in training of mid-level professionals to advance in the aging services field. Further, it provides for the development of online training for caregivers to demonstrate techniques for activities of daily living assistance, such as safe lifting and transferring of a disabled individual.
Older Workers - Enact legislation that assists older workers to remain in the workforce. NYSOFA supports the Older Worker Opportunity Act (S. 709), which would create tax incentives to employers for offering flexible and part-time work arrangements to older workers, and the Health Care and Training for Older Workers Act (S. 708), which continues COBRA coverage beyond the usual 18 months for workers age 62 or older who must leave their jobs.
NYSOFA also supports re-establishing a specific set-aside for older workers in the Workforce Investment Act (WIA), which is likely to be reauthorized in 2010. Previously, there had been a 5 percent older worker set-aside.
Veteran' Health: Support legislation (H.R. 1527) that would establish a three-year pilot program to allow "highly rural" veterans enrolled in four of the Department of Veterans Affairs' (VA) 21 health care networks to receive health services through outside providers. The bill defines highly rural as veterans seeking primary care who live more than 60 miles from the nearest veterans' facility; veterans seeking acute hospital care who live more than 120 miles from a facility; and those seeking tertiary care who live more than 240 miles from a facility. The bill also would allow veterans to access care at other facilities if VA determines that travel would be difficult for veterans or subject them to hardship.
Calling for 2-1-1 Act - Enact legislation (H.R. 211/S. 211) that would facilitate the nationwide availability of 2-1-1 telephone service for community information and referral on health and human programs and services. The bill would require state grant recipients to abide by Key Standards for 2-1-1Centers and to collaborate with human service organizations to provide an exhaustive database of services in their service area.
Medicare Reform - Engage in a national discussion on Medicare's long-term sustainability, while opposing reforms that would unduly harm beneficiaries. Our nation needs to have a rational, nonpartisan discussion about the sustainability of Medicare over the long-term, recognizing that Medicare spending is directly related to health care spending generally and that future challenges arise primarily from the increasing number of eligible beneficiaries.
A new Congress and a new President are expected to continue debate into 2009 regarding the provision in the 2003 Medicare prescription drug law that requires the authorized the Part D prescription drug program, as well as review many other Medicare provisions. Medicare should continue to enforce financially sound provisions of uniform, dependable, affordable, quality health care for older and disabled individuals. Accordingly, NYSOFA believes that a national Medicare dialogue should be guided by these key principles:
In addition, the Medicare Modernization Act should be amended to:
Social Security Reform - Strengthen Social Security solvency and oppose privatization. NYSOFA opposes the "partial privatization" of Social Security and "carve-outs" for private savings accounts, but would not necessarily oppose "add-ons" for these types of accounts. NYSOFA also opposes calculating initial retirement benefits on a price index rather than a wage index system.
NYSOFA supports consideration of a number of relatively modest changes that together would effectively deal with the long-term fiscal solvency challenge now facing Social Security. These include:
Supplemental Security Income (SSI) Reform: The SSI program provides means-tested monthly grants to low-income elderly, blind and/or disabled individuals. New York State supplements the federal SSI benefit, and the Social Security Administration administers New York's state supplement and charges the state for administrative costs. NYSOFA supports consideration of a number of changes to SSI:
If you have questions or need additional information, please contact Sandy Longworth, Director of Federal Relations, at (518) 474-0529 or e-mail her at sandy.longworth@ofa.state.ny.us.
