Network in Aging

Bob BlancatoNovember 6, 2014rblancato@matzblancato.com

Introduction•Thank you.•Honor to be part of the 34th annual meeting of the

Network in Aging of Western New York.•1980: Older Americans Act was a mere 15 years old

and 7 years after Congress created aging network.•Carter was in his last year. Reagan knocking on door.

Older Americans Act Then and Now•Time when OAA under a lot of attention.•Carter’s final budget proposed cuts for OAA

nutrition. Paper plate campaign helped stop it.•One year later Reagan budget eliminated funding for

SCSEP. Pink slip campaign helped stop that.•Now OAA almost 50 with a future?

Anniversaries•This conference held on November 6—two days after

mid term elections.•November 6 also marks the 96th anniversary of when

NY granted women right to vote.•And perhaps on 98th anniversary we will elect the

first woman President who happens to be from NY…

Early Analysis of Midterm Election•Senate

•House

NY Gubernatorial and Cong. Elections

Theme of Conference•Title of Conference is Aging Services in the 21st

century—National, State and Local Perspective.•Similar to theme of 1995 WHCOA: The Road to an

Aging Policy for the 21st Century.•Then as now it is about seeing the prediction of an

aging America take greater hold and what does it mean for aging services.

•For context, some important demographics.

Demographics•People 65+ numbered 43.1 million in 2012, an

increase of 21% since 2002.•13.7% or one in seven is 65+.•Racial and ethnic minority populations have increased

from 6.1 million in 2002 (17% of the 65+ population) to 8.9 million in 2012 (21% of 65+).

•Older women outnumber older men: 24 to 18 m.•The 85+ population numbered 5.9 million in 2012.•Older voter will grow from 16% of electorate in 2012

to 23% in 2016.

Where Do Older Adults Live?• In 2012, over half (59%) of persons 65+ lived in 12

states: California (4.6 million); Florida (3.5 million); Texas (2.8 million); New York (2.8 million); Pennsylvania (2.0 million); and Ohio, Illinois, Michigan, North Carolina, New Jersey, Virginia, and Georgia each had well over 1 million.

•Most persons 65+ lived in metropolitan areas in 2012 (81%). About 66% of these older persons lived outside principal cities and 34% lived inside principal cities.

Projections: 2030•72 million 65+ in 2030, when all boomers will be 65+:

19.3% of the population.•8.7 million will be 85+ in 2030.•Minority population will have increased to almost

29% of 65+, Hispanic share alone increasing by 5% (from 7% to 12%).

•Women continue to outnumber men, but not by as much as now percentage-wise.

New York By the Numbers•60+ population: 3.5 million in 2009.•2030: 5.3 million people over 65.•Census projects that 26% of the state will be 60+ in

2030.• In just 3 years, fewer than 8 counties in NYS will have

a less than 20% share of 60+.•38.2% of NYS’s 60+ population lives in New York City.

(43% of the state overall lives in NYC).

Topics for Today•2015 White House Conference on Aging.•Affordable Care Act.•Medicaid redesign.•Elder Justice.•Retirement Security.•Healthy Aging.•Should note that the last three match 3 of the 4

priorities of the WHCOA.

2015 White House Conference on Aging

• Has been confirmed for 2015.• Nora Super is the Executive Director.• 6th one in history.• Conducted equally by Democratic and Republican Presidents.• Purpose is to help shape national aging policy for next ten years.• Website at www.whitehouseconferenceonaging.gov.• Four themes:▫ Long term services and supports▫ Elder justice▫ Retirement security▫ Healthy aging

ACA and Seniors•ACA: Landmark, controversial, transformational,

divisive, huge political issue 2014/2016.•ACA has been beneficial for Medicare.•Delivery system reforms, stronger work on fraud and

abuse, more preventive services all will lead to stronger Medicare.

•Trustees: extended solvency of Trust Fund by 13 years to 2030.

•More preventive services.

ACA and Seniors•Closing donut hole completely by 2020: Prevention

through adherence.•New initiatives to support care coordination.•Care transitions to lower hospital readmissions.• Improvements to Medicare Advantage plans—

stronger and less expensive.•Holding Part B premiums down.• Important programs for New York such as the

Balancing Incentive Program which will include no wrong door/ standardized assessments.

Medicaid Expansion• Supreme Court decision made this an option under the

ACA: 28 states/DC have and 23 have not (19 said no; 4 in decision process).

•NY one of the states that expanded Medicaid.• Problem: finding that provider networks inadequate. In

some states, patients must wait for months for services.• Regulations are designed to prevent these problems.

NY one of three states accounting for 3/4 of all violations reported in last five years, but most states not even issuing violations.

Other Medicaid Issues• Inconsistent Medicaid expansion.• Increased ranks and the 3rd year of expansion.•Role of managed care in states. Will rise from 57% of

all beneficiaries covered in 2011 to 75% of all Medicaid and CHIP enrollees covered in 2015.

•Continue emphasis on move to home and community based services as key element of long term services and supports.

•Medicaid spend-down and estate recovery.

Long Term Services and Supports•A denial issue for America in general.•Must address financing (public/private).•Effort in Affordable Care Act (CLASS Act) failed.•New ideas are developing.•Greater emphasis on home and community-based

care—not emphasizing “long term care” anymore, emphasizing “services and supports” to enable people to remain at home.

Elder Justice•Elder abuse, neglect and exploitation called the

crime of the 21st century.•1 in 10 older adults will be a victim.•6 million total cases are reported every year.•Only 1 in 23 cases reported according to NYS study.•Average victim is an older woman living alone. Nearly

half of all women 75+ live alone.•$2.9 billion in 2009 was lost to financial exploitation.•1 in 2 people with dementia will be a victim.

Elder Justice Act• Landmark Elder Justice Act passed in 2010 as part of

ACA.•Most comprehensive bill ever on elder abuse.•Enhance paltry federal response to problem.•Key provision dedicated funding to Adult Protective

Services.•Elder abuse cannot be stopped if not reported.•APS case loads increasing—resources are not.▫Currently 13 states have no federal funding.

Elder Justice Act•EJA dedicated funding and also enhanced training for

best practices.•EJA supports long term care ombudsmen.•Forensic centers, improved staffing.•Separate but related: criminal background check bill.•2014 and 2015 pivotal years for Elder Justice Act.•Still no direct Congressional funding.•Obama proposed Elder Justice Initiative.•FY 15 budget not finalized.

Elder Justice Act• Law needs to be renewed—expired at the end of

September.•Federal government response is improving within

existing programs and resources.▫New Office of Elder Justice and APS

•Nothing automatic as OAA struggle proves.•Naming elder justice as priority issue for WHCOA

important.

Retirement Security•Key issue in changing times.•Retirement different meaning in 21st century.•Retirement security and increased longevity linked.•Fewer pensions.• Low savings rate in boomer generation.•Now 50-68 with economic security in later life more

important issue.

By the Numbers•22% of private-industry workers currently get a

pension benefit versus 42% in 1990. (92% of govt employees get a pension.)

•Our savings rate in the US will be 4.1% this year, down from 10% or more 40 years ago. It was 2.5% pre-recession.

The Savings Crisis•36% of workers have saved less than $1,000. 69%

have saved less than $50,000 and just 11% have saved more than $250,000.

•Among those retired, 29% have saved less than $1,000 and 17% have saved more than $250,000.

•Experts estimate that if you earn $75,000 a year, you will need a nest egg equal to $600,000 to $900,000.

The Great Recession and Retirement (In)security

•Older workers make up more than half the long-term unemployed.

• The median earnings replacement rate for workers 55-64 who lost jobs from 2007 to 2009 was 85%, compared with about 95% for workers aged 25-54, the GAO found.

• An AARP analysis found 1.5 million people over 50 had lost their homes to foreclosure between 2007 and 2011 and another 3.5 million owed more than their homes were worth.

•One survey of post-50s found 25% had used up all of their savings between 2007 and 2010.

How to Retire Securely?•Great need for financial literacy: start young!•Older workers’ programs like SCSEP and vocational

education and training.•Alternatives to pensions—mandatory employment

based savings plans.•Consider health care costs—long term care insurance

an option? •Caregiving and its inevitability and need for support.•Protection of assets from fraud and exploitation.•CPI-E.

Healthy Aging•No one against it.•Can transform negativism about aging.• Longer life/better life.•Proactive prevention through lifespan key.• Importance of nutrition to healthy aging.•Growing problems of food insecurity, hunger and

malnutrition.•Access to food and right kind of food critical.

Healthy Innovations•Apps and other technical components — “Aging 2.0.”•Where and how you live can determine healthy aging•Reinventing the wheel of livable community, going

back to the close-knit “village” model from spread-out suburbia.▫From “retirement community” to the NORC.

•About aging in place.•People staying in their homes versus going into a

nursing home—retrofitting and reimagining spaces.

Healthy Aging Policy•Need unified policy in 21st century.• Linking housing, transportation, services,

employment, access to health care toward goal of livable community that is intergenerational and culturally sensitive and competent and has special recognition for caregivers.

Aging Network: The Future• Aging network now 40 years old.• Must adapt or become obsolete.• Time of great challenge and opportunity.• Challenge comes from possible competition in service space.• Opportunity comes when network is seen as critical by the

competition.• Build business case:▫ Better communication.▫ Pricing of services.▫ No wrong door.

• Work to strengths of network (service coordination and delivery; information and education; trusted entity to older persons).

Public-Private Partnerships•Aging network perfect example of a place for public-

private partnership—and already an example of some of the best programs of this kind.

•As funding dollars grow more scarce, these partnerships grow more necessary.

•Meals programs, etc. working with vendors to provide services.

•More advanced: meals programs and AAAs partnering with health corps and hospitals, which is already happening.

Funding Opportunities•ACA through care transitions, Medicaid expansion,

rebalancing all provide opportunities for aging network in future.

•New and deeper funding streams.•New power and responsibility.•Aging networks are known and trusted entities in

communities.•A strength in future relationships.

Closing• Aging services in the 21st century will be needed in ways

they are provided today and in ways not yet seen.•What does the older person in 21st century want in

services as consumers?• They want choice, continuity, a continuum approach.• They want services to be person centered with

outcomes that can be measured.• Greater emphasis on prevention and wellness.• Simplification.• Cultural competency.

Closing• You have focused on an important topic for reasons

captured in these two quotes:▫ “It’s getting late early.” Yogi Berra▫ “Even if you are on the right track, you’ll get run over if

you just sit there.” Will Rogers• Future of aging services is driven by local decisions

and needs.• Yet advocacy also needed to get resources.• Keep up the good work and remember, best advocacy

is applying gentle pressure but applying it relentlessly.