Congress and the White House will soon engage over budgetary issues and the national debt. They will debate political theory, public policy, and fiscal management. They will fight over budgets and taxes. The outcome is hardly predictable.
The result of this epic annual struggle will impact millions of Americans, particularly older people. Decision makers should understand the current state of knowledge about older people and how budgets will affect them. Ill-advised decisions negatively affect the health and well-being of older people; they will increase federal and state budgets as well. This year Miami-Dade and Monroe counties lost $1.2 million in supportive services under the Older Americans Act, including over $700,000 in meals, because of sequestration. This cannot happen again.
We are fortunate to have a rich body of research supported by the National Institute on Aging (NIA). The data confirms that older people live longer today and function at a higher level than in 1965 when Medicare, Medicaid, and the Older Americans Act were enacted into law.
Nationally, there has been both a decrease in the incidence of disability among elders and an increase in recovery from disabling conditions since 1965. Disability rates among those 65 to 84 remain steady. People aged 55 to 64 today (“Boomers”) experience a 1-percent annual increase in disability, however, meaning that every year 365,000 more people have difficulty carrying out activities of daily living.
They are challenged to remain at home and live independently. Difficulty with daily personal care and household activities increases with age. Therefore, it makes sense to provide home-delivered meals, home modifications such as grab bars in the shower and lever door handles in the kitchen, and other inexpensive services that enhance independence.
Because frailty tends to be more prevalent among elders in low-income, African-American and Hispanic communities, supporting them costs taxpayers much more if they have to be placed in nursing homes paid for by Medicaid (approximately $60,000 per year compared to an average annual cost of $5,000 for home-based services under the Older Americans Act). Access to information and services is essential to sound public policy. The overarching goal of the Older Americans Act is to facilitate access to these cost-effective, community-based services.
There are other areas where responsive public policy can address the challenges of aging: abuse and financial exploitation; support for caregivers; and meaningful social connection. People with physical or cognitive disabilities or who live alone are at greater risk of mistreatment and exploitation. Abuse and exploitation by family members, caregivers or others increase the risk of death threefold. Elders need to have much greater connections with available community resources.
Likewise, there are inexpensive approaches to support caregivers. Stress, not caregiving activity itself, increases health risks of caregivers and affects their ability to provide care. Training, respite care and other social supports, including exercise and meditation, make meaningful differences in the lives of caregivers, especially those caring for loved ones with Alzheimer’s Disease and other dementias.
According to NIA, “Spending on community-based services for certain groups of older adults appears to prevent or postpone more costly nursing home care.” Researchers have concluded that “investing in home-delivered meals could keep people in their homes longer and avert public and private spending on nursing homes.” In fact, research confirms a correlation between the level of state spending on home- and community-based services and reduced nursing home admission of elders without children.
Finally, there is increasing evidence “that older adults who are involved in social and community activities remain mentally and physically healthy longer” than others. They live longer, at a higher functional level, are less depressed, and rate their own health higher. We need to encourage volunteering and other forms of social and community engagement. It enhances self-esteem, a greater sense of purpose, and overall health.
Responsive public policy and sound fiscal investment need to build upon foundations established by this research. Over half a million older adults make South Florida their home. Let’s make thoughtful policy and fiscal decisions to help keep them there.
Max B. Rothman is president and CEO at the Alliance for Aging, Inc., covering Miami-Dade and Monroe counties.