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Current Issues in Aging: Campell

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This presentation was delivered at NADO's 2018 Annual Training Conference, held in Charlotte, NC on October 13-16. For more information, visit: https://www.nado.org/events/2018-annual-training-conference/

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Current Issues in Aging: Campell

  1. 1. National Association of Area Agencies on Aging Current Issues in Aging 2018 NADO Annual Training Conference, Charlotte, NC Autumn Campbell, n4a October 16, 2018
  2. 2. National Association of Area Agencies on Aging
  3. 3. National Association of Area Agencies on Aging Consumer Publications
  4. 4. National Association of Area Agencies on Aging Agenda • Fast Facts About the Aging Network • Federal Budget and Funding for Aging Programs • Older Americans Act Reauthorization • Building the Bridge to Health Care • A Look Into the Crystal Ball • Questions?
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  9. 9. National Association of Area Agencies on Aging Growing Needs/Growing Numbers of Older Adults 2016 Top 5 Purpose of Call to the Eldercare Locator Purpose Percentage Transportation 21% Home and Community Based Services (HCBS) (In-Home Svcs 11%, Nutrition Svcs, 4%, Senior Center Programs 3%, LTC 2%, Case Management 1%, Employment 1%) 20% Housing 9% Medical Services and Supplies (Medical Services 6% and Medical Supplies and Equipment 3%) 9% Health Insurance 6%
  10. 10. National Association of Area Agencies on Aging An Aging Network on the Move
  11. 11. National Association of Area Agencies on Aging Funding and Coordination of the Aging Network
  12. 12. National Association of Area Agencies on Aging All AAAs play a key role in:
  13. 13. National Association of Area Agencies on Aging Responding to the Needs: AAA Trends and Directions • Increasing Demand for Services with Limited Budgets • Serving Broader Population • Expansion of Health-related Services • Expansion of Work in Integrated Care • Increased Interest and Activity in Business Acumen and Business Development to Meet Needs/Diversify $
  14. 14. National Association of Area Agencies on Aging
  15. 15. National Association of Area Agencies on Aging Outreach A core role of AAAs is to create local information and referral/assistance (I&R/A) hotlines to help consumers find aging and other HCBS programs. With these resources and a portfolio of other outreach tools including public education, staff and volunteers, ADRCs and SHIPs, AAAs are able to assist clients match services and solutions to their individual needs, enabling consumers to age in place with increased health, safety and independence.
  16. 16. National Association of Area Agencies on Aging Nationwide Network with a Local Flavor • In 2017, there are 622 AAAs serving older adults in virtually every community in the nation. • In a few small or sparsely populated states, the state serves the AAA function. • The OAA is foundational for all AAAs, but because the law calls for local control and decision-making, AAAs adapt to the unique demands of their communities to provide innovative programs that support the health and independence of older adults.
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  18. 18. National Association of Area Agencies on Aging AAAs vary widely in size as each state determines how many service areas to establish, which then determines the number of operating AAAs. For example, Wisconsin has 3 AAAs, but New York has 59.
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  21. 21. National Association of Area Agencies on Aging Aging Services Offered by AAAs Percent n=412 Legal assistance 92% Respite care 89% Benefits/health insurance counseling 85% Transportation (non-medical) 85% Case management 82% Homemaker 74% Personal assistance/personal care 74% Options counseling 72% Assessment for care planning 70% Ombudsman services 70%
  22. 22. National Association of Area Agencies on Aging Aging Services Offered by AAAs Percent n=412 Enrollment assistance 64% Home repair or modification 64% Transportation (medical) 63% Senior Center 61% Emergency Response Systems 58% Assessment for long-term care service eligibility 58% Chore services 57% Adult day service 55% Evidence-based caregiver programs 51%
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  24. 24. National Association of Area Agencies on Aging New Trends in the Aging Network
  25. 25. National Association of Area Agencies on Aging Broader Roles of AAAs
  26. 26. National Association of Area Agencies on Aging Tar Heel State Area Agencies on Aging
  27. 27. National Association of Area Agencies on Aging Tar Heel State Area Agencies on Aging More Information at: https://www.n4a.org/2017aaasurvey
  28. 28. National Association of Area Agencies on Aging Federal Aging Policy Update
  29. 29. National Association of Area Agencies on Aging Aging Policy Challenges • Lack of understanding, acceptance among lawmakers, public of how huge this aging of the population is • Room to move on crafting good aging policy! – E.g., many states still not rebalanced, few truly livable communities, treatment vs. wellness/prevention • Uncertainty about long-term financial stability of key social safety net and social insurance programs • Short-term instability on annual federal budget (appropriations)
  30. 30. National Association of Area Agencies on Aging Federal Budget and Funding for Aging Programs
  31. 31. National Association of Area Agencies on Aging OAA Federal Funding Status
  32. 32. National Association of Area Agencies on Aging Most of the Federal Budget = Defense, Social Security and Major Health Programs Chart Courtesy of Center on Budget and Policy Priorities
  33. 33. National Association of Area Agencies on Aging Federal Budget Snapshot In FY 2017… • Total Federal Spending = ~$4 Trillion • Total Non-Defense Discretionary Spending = $610 Billion (~15.25 percent) • Total Older Americans Act Spending = ~$2 Billion • Total OAA Spending as percentage of Federal Budget = .05 percent
  34. 34. National Association of Area Agencies on Aging A Look Back: Budget Battles, 2011-2018 • Recession, changes in politics drove louder conversation about federal debt (and deficit) • July 2011: Budget Control Act = caps, threat of sequestration, Super Committee, debt ceiling relief • March 2013: Sequestration • October 2013: Shutdown • Series of two-year budget deals (FY14-15/FY16-17), partially offset sequester/caps • Jan-Feb 2018: Two shutdowns • February 2018: Third two-year budget deal (FY 18-19), partially offset sequester/caps
  35. 35. National Association of Area Agencies on Aging Trump Administration Budget FY 2019 • Deep cuts to Non-Defense Discretionary (domestic) programs (>40 percent/10 years) overall • “Flat” funds most core Older Americans Act programs • Cuts/eliminates critical domestic programs serving older adults (SCSEP, SHIP, SSBG, CDBG, CSBG, LIHEAP, Housing, Transportation) • Guts Medicaid (states will limit HCBS) • Repeals ACA (higher premiums, double uninsured rate among pre-Medicare population) • Nutrition assistance eliminated for 1 million seniors • Cuts SSDI for 6 million people over 55
  36. 36. National Association of Area Agencies on Aging …BUT Congress Is Where the Action Is Theory: – Budget resolutions passed by both chambers, agreed to; sets high-level spending limits – Appropriators develop 12 bills, move through committee and to floor – Everything done and signed by President by Sept. 30 Reality: – After five CRs, two shut-downs and significant compromises, final FY 2018 funding passed in March 2018 (nearly six months into FY) – FY 2019—Return to “Regular Order”
  37. 37. National Association of Area Agencies on Aging Bipartisan Budget Agreement for FY 2018-19 (February) Highlights – Rejected major cuts to domestic programs President requested in FY 18-19 – Increased discretionary caps (for defense and non-defense) by $300 billion over two years – Included the CHRONIC Care Act (more on that later!) – Closed the Part D Donut Hole in 2019 – Included $80 billion in disaster relief funding – 10-year reauthorization of CHIP – Funding for opioid response
  38. 38. National Association of Area Agencies on Aging Older Americans Act BIG INCREASES! • + $35 million for Title III B Supportive Services • + $40 million for III C 1 Congregate Nutrition • + $19 million for III C 2 Home-Delivered Meals • + $5 million for III D Preventative Health • + $30 million for III E National Family Caregiver Support Program • + $4 million for Title VI Native American • +$1 million for Title VII Ombudsman [HUD Section 202 +$105 million, Service Coords +$90 mil] What Happened in FY 2018? (March)
  39. 39. National Association of Area Agencies on Aging Other Administration for Community Living • State Health Insurance Programs preserved with $2 million increase to $49 million • Elder Justice (APS) Initiative, 20% boost to $12 million • Aging and Disability Resource Centers boosted 32% to $8 million • CDSMP level at $8 million, Falls Prevention level at $5 million (Prevention and Public Health Fund) • Lifespan Respite up 22% to $4.1 million • Holocaust Survivors doubled to $5 million FY 2018 Final Levels
  40. 40. National Association of Area Agencies on Aging Other Agencies, Proposed for Elimination • OAA Title V Senior Community Services Employment Program level funded at $400 million (Dept. of Labor) • Social Services Block Grant, $1.7 billion • Community Services Block Grant, $715 million • Low-Income Home Energy Asst, boosted $240 million to $3.6 billion • Senior Corps, $202 million • Community Development Block Grant, $3.24 billion, a boost of $235 million FY 2018 Final Levels
  41. 41. National Association of Area Agencies on Aging What About FY 2019? Return to (roughly) Regular Order • Labor-HHS Funding signed into law on Sept. 28 • Continuing Resolution (CR) for other agencies until December 7 • $855 billion funding bill contains $178 billion for Labor- HHS (including OAA/other Aging Programs) • First time in 22 years! • 9 of 12 bills passed in Senate; 7 of 12 bills passed in House
  42. 42. National Association of Area Agencies on Aging What About FY 2019? An FY 2018 Redux for OAA/Aging Programs - Labor/HHS put with Defense bill - Full-year funding! - OAA programs mostly flat at FY 2018 levels - Preserves 2018 increases - $10 million increase for Title III C Nutrition Programs - Make other small increases (OAA Title VI, RAISE, GRG, Caregiver Corps) - Avoids eliminations for key programs - Increases funding for CSBG ($10 million) and LIHEAP ($50 million)
  43. 43. National Association of Area Agencies on Aging Older Americans Act Reauthorization Lyndon Johnson signing the OAA, July 14, 1965.
  44. 44. National Association of Area Agencies on Aging Timeline of Major Amendments 1972 – Nutrition program 1978 – Home –delivered meals authorized and ombudsman services required 1992 – Elder rights recognized 1973 – AAAs created; multipurpose senior centers and community service employment authorized 2006 – HCBS systems thru ADRCs; evidence-based health promotion services 2000 – National family caregiver support program 1965 Present (Preparing for 2019 OAA Reauthorization) 2016 – Small changes to definitions, specific authorization levels
  45. 45. National Association of Area Agencies on Aging Topics included: Rising Demand Eligibility Flexibility Transfer Authority Targeting Cost-Sharing Data Collection Private Pay ADRCs
  46. 46. National Association of Area Agencies on Aging Older Americans Act Reauthorization (current law expires Sept. 30, 2019) n4a Process on OAA • June-August: Preparatory phase—hearing from the field; developing high-level approach • July-August: Comprehensive survey of n4a members • Currently: Review survey results, develop initial priorities. • November 6: Election will inform specific advocacy strategy • Early 2019: Release n4a OAA reauthorization priorities to new Congress and start advocating! Coalition Process on OAA • May-August: Leadership Council of Aging Organizations (LCAO) reviewing 2011 coalition priorities • September-October: n4a taking a leading role in negotiations to determine and elevate priorities among the 72-member coalition • November-January: Approve comprehensive list of LCAO priorities and identify top few to highlight for the Hill. Determine coalition advocacy strategy. • Early 2019: Release LCAO OAA reauthorization priorities to new Congress and start advocating!
  47. 47. National Association of Area Agencies on Aging Building the Bridge to Health Care
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  49. 49. National Association of Area Agencies on Aging Social Needs Affect Health In a survey of 1,000 physicians:  85% say unmet social needs directly leading to worse health  85% say social needs as important to address as medical conditions  80% not confident in their ability to address social needs Source: Robert Wood Johnson Foundation, http://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2011/rwjf71795
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  51. 51. National Association of Area Agencies on Aging Medicare: New Opportunities Abound? • Medicare largest federal health care program • Health happens at home: 80 percent of health care costs are attributed to SDOH • Traditionally, Medicare has not touched these factors
  52. 52. National Association of Area Agencies on Aging Medicare: New Opportunities Abound? Emerging Opportunities for CBOs in Medicare • CHRONIC Care Act (passed Feb. 2018) • Medicare Advantage Call Letter for 2019 • Legislative proposals to add LTSS to Medicare Challenges • Not available for all beneficiaries • Late notice for Medicare Advantage plans to implement this year • Cost
  53. 53. National Association of Area Agencies on Aging But What About Medicaid? • 6 million low-income seniors and 10 million people with disabilities receive services and supports through Medicaid (=62% of Medicaid spending) • Two-thirds of seniors in nursing homes rely on Medicaid • 39% of American children are covered by Medicaid (=21% of Medicaid spending) • Overall, Medicaid covers nearly 80 million low-income Americans • 15% Medicaid spending covers non-disabled low- income adults
  54. 54. National Association of Area Agencies on Aging AgingandDisabilityBusinessInstitute.org
  55. 55. National Association of Area Agencies on Aging Another Medicaid Issue: MFP Money Follows the Person • Medicaid rebalancing program, transitioned over 88k people from institutional settings back to the community • Bipartisan program with 12+ years of success; expired at the end of FY 2016 • States running out of MFP money—ramping down programs; losing infrastructure • Bipartisan House/Senate bills to reauthorize: EMPOWER Care Act (H.R. 5306 & S. 2227) • House marked up its bill last month! • See n4a.org/advocacy for what you can do to support MFP reauthorization
  56. 56. National Association of Area Agencies on Aging Funding for OAA/Aging Programs • FY 2019 stability for OAA/Aging programs • Fights over budget caps will start again next year Health Care Proposals • Limited legislative traction due to election • Administrative action will continue • Potential: MFP OAA Reauthorization • Education is important through the end of the year • Potentially high priority in early 2019—election will determine strategy A Look Into the Crystal Ball
  57. 57. National Association of Area Agencies on Aging What Can Aging Advocates Do?
  58. 58. National Association of Area Agencies on Aging Key Advocacy Reminders • Educate, educate, educate your elected officials about the importance of OAA programs and delivering aging services in the home and community! • Build relationships with Members/staff • Engage candidates in your work (site visits!) • THANK your elected officials for advocacy wins • Keep them informed about what is going on in your community • Engage with the media, too
  59. 59. National Association of Area Agencies on Aging Use n4a’s Advocacy Tools!
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  62. 62. National Association of Area Agencies on Aging Questions? Autumn Campbell, Director, Public Policy & Advocacy acampbell@n4a.org

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