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The Gerontology Institute at my university has been collaborating with Wider Opportunities for Women on the Elder Economic Security Standard Index (EESSI) for quite some time. I was a part of this project during my assistantship back in 2011. The project focuses on each state in the nation, breaking it down to the county level, to determine how much elders actually need to maintain their independence and meet their costs of daily living. It was very important to bring this kind of assessment down to the state and county level, which is not how the poverty threshold used by our government works. For one thing, the costs of housing, child care, health care, and transportation vary greatly based on where you live.

Though the EESSI measured poverty on these levels, it came to a startling conclusion about the nation as a whole.  Even though costs vary based on where you live, in every state and every county the poverty threshold for an individual ($10,890/yr) or the average Social Security benefit ($14,105/yr) is NOT enough to maintain independence, and these elders needed housing and health care supports to cover their basic expenses.

The purpose of this tool is to have “a measure of income adequacy that respects the autonomy goals of older adults, rather than a measure of what we all struggle to avoid – poverty.” Some of the Gerontology Institute’s other findings include: (1) Housing costs are the greatest expense for most elder households, and elders can spend up to half of their income on housing. (2) A major life change, such as the death of a spouse or a major health shock, can create a situation where someone who was once meeting their expenses can no longer do so.

Check out the full report here to learn more: http://scholarworks.umb.edu/gerontologyinstitute_pubs/75/

If you want to learn more about adequate income for your state and county, look at WOW’s website: http://www.wowonline.org/ourprograms/eesi/

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Every non-profit or academic institution focused on aging in America (e.g. AARP, Older Women’s League, American Society on Aging, etc.) supports the American Care Act. It’s great news that the Supreme Court ruled the law was constitutional. With this ruling, insurance companies will no longer be able to deny coverage, or charge more because of a pre-existing condition, or force women to pay higher premiums than men. Preventive care will continue to be covered at no cost, and seniors will continue to save money on prescription drugs (5.3 million Medicare Part D beneficiaries have already saved $3.7 billion on prescriptions since the law was enacted).

The ACA is a major step toward ensuring affordable and quality health coverage for millions of working families, elders, and children. Therefore, it is surprising to me that many Americans don’t believe the ACA will help them. A Kaiser Family Foundation report found that people believe young adults and children are likely to benefit from the new law, but not themselves or their families. Thirty-seven percent of respondents felt the law will make no difference in their lives, thirty-one percent felt they will be worse off.

Where are these answers coming from? Is it that a case being brought to the Supreme Court is enough to reduced people’s opinions of the law? Who are the individuals against the ACA…do they understand the implications for American’s health system and the American people’s well-being?

The ACA is in no way perfect, but many of the laws are designed specifically to help older people acquire and pay for comprehensive health care. An AARP article lists the number of ways the law supports older adults:

  • Insurance companies cannot drop you if you become sick or disabled
  • They cannot have lifetime dollar limits on your coverage
  • Medicare recipients receive annual wellness visits, preventive services, and immunizations at no additional cost
  • As mentioned, people with Medicare Part D now receive discounts on prescription drugs while in the doughnut hole. The Part D discounts will gradually increase until 2020, when the doughnut hole will close
  • In 2014, insurers can no longer deny coverage if you have a preexisting condition
  • In 2014, insurance “exchanges” will provide better access and options to self-employed people, small businesses and others who are unable to find affordable coverage

The Supreme Court’s decision is a significant move in the right direction. It will help the United States build a health care plan for our future that is on par with what other developed nations provide already: Affordable health care coverage as a right, not a privilege.

The Older Women’s League has come out with their 2012 Mother’s Day report. Their reports are always thorough, up-to-date, and readable. This year the topic is on women in the U.S. workforce and highlights what women are faced with as they grow older. As OWL’s president mentions in her message to readers, this is a timely report since mid-life and older women are the fastest growing segment of our workforce and the economic downturn presents new challenges in their ability to find work, keep their jobs, and build their retirement wealth.

Women and the Workforce: Challenges and Opportunities Facing Women as They Age

MDR2012

From the OWL National Website: “This year’s report looks at how factors such as unemployment and underemployment, pay inequality, caregiving, age and gender discrimination, and education, training, and technology are impacting women age 40 and older. The report highlights existing programs that produce real results and offer innovative solutions and policy-driven recommendations to expand economic diversity and accelerate our nation’s productivity.”

The 2011 OWL Mother’s Day report  starts with a very strong statement: “Health care for all is a women’s issue…” Why would this be? Men also need and use our health system. Yet, the case is made for how women’s lives are affected by health care coverage or a lack there of. Women play a large role in managing care for sick family members, most often providing this care themselves. Widows can often be left impoverished if their husbands’ chronic illnesses dwindled savings accounts and assets. In late life, women find themselves 60% more likely to need help with basic daily activities (i.e. eating, dressing, bathing) compared to men. This paints a picture in our minds: Grandma spent her 60’s and 70’s caring for grandpa. He had heart problems and diabetes but she made sure he took his medications, got to his appointments, and was cared for till the end. Now in her 80’s, grandma finds herself sick, poor and alone in a big, empty house. Since women’s life expectancy continues to exceed that of men’s, this story is all too familiar.

“After a lifetime of caring for others, older women often need affordable care but find that the costs are high and their options are severely limited.” I’ve described to you a common late-life situation for women. Let’s keep this image in our minds as we discuss how the Affordable Care Act (ACA) aims to support Americans as they age. People, like grandma, find themselves skipping preventative services because Medicare requires them to pay a 20% co-payment. This cost is found to be a disincentive for approximately half of Medicare beneficiaries who do not use preventative services available to them.  Grandma lives on a fixed income of $1,000/month from Social Security (the average benefit is $1,177) and this means that paying a $30 co-pay to see her doctor gives her $30 less for grocery shopping that month. She isn’t feeling sick, so she prefers to spend the money on food. This begs the question: Should she have to make that choice?

 
The good news is changes to our health care system are happening over the next few years and should support people in old age. Below I’ve highlighted some of the changes but please read the full report or see this great summary of the Health Reform Law from the Kaiser Family Foundation for more details.

Health Insurance Reforms

  • Medicaid will be expanded to cover 16 million Americans (all legal residents up to 133% of the federal poverty level will be eligible)
  • Retroactive cancelling of insurance because of accidents or sickness, denying coverage because of pre-existing conditions, and basing premiums on health status, gender and genetics will all be prohibited
  • Insurance companies must devote at least 80 – 85% of premium dollars received to medical benefits and quality improvement and they must provide justifications for any excessive rate increases, making this information available to consumers

Medicare

  • People who reach the “donut hole” on prescription drug coverage will get a large discount on drugs and biologics and this discount will grow each subsequent year.  The hole will be closed in 2020
  • Beneficiaries will receive a free annual exam, free flu and pneumonia shots, and any covered service that is given a grade A or B by the U.S. Preventive Services Task Force must be provided at no cost
  • Medicare payments will be reduced for hospitals that have high HAC rates (hospital-acquired conditions) and incentives will be provided to hospitals that improve their transitional care and partner with community services to reduce readmission rates

Long-Term Care 

  • The Community Living Assistance Services and Support (CLASS) Act will provide a voluntary long-term care insurance program available to all working Americans. When an individual becomes eligible and needs long-term care services an average cash benefit of $50/day will be given to help them pay. Beneficiaries have control over their own care, so this includes paying family or friends who provide help at home.
  • Home and Community Based Services (HCBS) aim to provide a network of services within state and local areas to meet the needs of elders aging in place. A new protection called under HCBS will attempt to prevent “spousal improverishment” by only counting the ill spouse’s income when determining eligibility.
  • Nursing home care will be improved as the ACA aims to make the system, procedures, staffing and care more transparent and regulated. The Elder Justice Act is a part of this, in an attempt to identify and prevent elder abuse.

In the United States everyday people are providing 85% of needed long-term care for their family members and friends. These roles are generally unpaid and at the expense of their own careers, health, and well-being.  Rather than creating a health system that works, we have created a system that to a large extent depends on informal caregivers yet still costs us 17% of GDP.  The ACA is not a perfect system and will not be fully up and running for a few years. Still, it is a step in the right direction and will expand coverage to 95% of the population and support those who care for the people they love.

If you find yourself bombarded with mixed messages or feeling confused about the new health care changes, I encourage you to at minimum read the OWL Mother’s Day report’s appendix. Here the authors address a number of major myths about the Affordable Care Act and answer some common questions about the policies and coverage.

2010 saw the passing of the Elder Justice Act (EJA), the most comprehensive federal elder abuse law in U.S. history. We know from earlier studies that roughly 11 to15% of people ages 60 and older face some form of elder abuse each year. Experts agree this number is under-reporting and the scope of the problem is larger than we realize. According to a 2008 study by the Metlife Mature Market Institute et al., the perpetrators of elder financial abuse are typically not strangers. They are often businesses, service providers, family and friends who have gained the trust of the older adult. Here are some interesting findings:

  • The victims of elder financial abuse are losing a combined total of $2.9 billion dollars annually.
  • Women are twice as likely to be victims of financial abuse as men. Most of these women are age 80-89, living alone, and requiring some help in the home or with their health care.
  • Nearly 60% of the perpetrator were men, mostly aged 30-59.
  • The amount of money stolen by family or friends increased during the holidays.

Recently the researchers at MetLife updated these numbers, discovering that elder financial abuse cases have risen 12% since 2008. Though instances are increasing, data suggests that only one out of 43.9 financial exploitation cases are reported. Unfortunately the newly passed EJA can do nothing without the support of Congress and the President. Currently the Act only provides Congress with the authority to spend up to $777 million over the next four years on elder abuse. To actually see the money used, however, a separate bill must be passed by Congress and signed by the President.

Until this can get sorted out, and the EJA can strengthen existing adult protective services (APS), here are ways the report says you can watch out for yourself:

  • Stay Alert – Don’t leave valuable items, cash, or checkbooks out in the open. Don’t be left out of decisions about your finances. Don’t sign anything without reading first and having someone you trust review it. If you are a concerned family member, be sure to ask periodically about the elder’s financial situation and keep an eye out for changes in their behavior (i.e. sudden worry about money) and any other sudden financial changes or unusual expenses.
  • Stay Organized – Keep track of possessions, mail, and checking and savings account balances. Know who is calling and use an answering machine or caller ID to screen calls. Know who is asking for personal information and why (never provide this over the phone!)
  • Stay Informed – Know where to go if you suspect abuse (your local APS, the police, or get help from bank employees). Talk to an attorney and keep track of your will, future caregiving arrangements and power of attorney.
  • Report Abuse – Anyone (e.g. elder, family member, physician, bank teller, etc.) suspecting elder abuse should be reporting it to the local APS. Reports can be made confidentially and reporters are protected from civil and criminal liability. It is always better to err on the side of caution.

The Elder Justice Act comes almost 40 years after the passage of the Child Abuse and Neglect Prevention Act. Congress, and the general public, see the value in protecting vulnerable children from abuse and today we spend upward of $7 billion to help this effort. Surely vulnerable older adults deserve the same protection.

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