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Health Care Provider Survey Findings:  Addressing Food Insecurity Among Older Adults —  Health Care Provider Beliefs, Practices, and Resources

July 20, 2023

The Food Research & Action Center and AARP Foundation collaborated with Dr. Rachel Zimmer of Atrium Health Wake Forest Baptist and Dr. Kimberly Montez, Wake Forest University School of Medicine, and conducted a survey to learn more about current efforts and promising opportunities for doctors, nurses, and other health care providers to address food insecurity among their patients 50 years of age and older. This report summarizes the findings of the survey responses from 144 health care providers. It also provides recommendations to enhance efforts by health care providers to address food insecurity informed by the survey findings.

Many older workers have difficult jobs that put them at risk

May 17, 2023

There is a looming retirement crisis in the United States. Millions of people are entering their retirement years with insufficient savings to cover basic expenses and medical bills. In response, some policymakers have proposed that older Americans could delay retirement to increase their savings. This solution, however, overlooks the large group of older Americans who work in difficult conditions—ranging from the physically demanding to the outright dangerous. If older Americans endure difficult conditions that often force earlier exits from the workplace, proposals to delay retirement make little sense.Supporting workers' access to jobs that pay fair wages and provide solid benefits during their prime working years is a more effective way to close the retirement savings gap than forcing workers to delay retirement. To ensure older workers can afford to retire when they need to, policymakers must: provide support for workers with caregiving responsibilities, expand Social Security coverage and benefits, and bolster health and safety protections in the workplace.

Unsustainable: Alabama's Increasing Trend of Keeping the Elderly Behind Bars

November 4, 2022

Alabama's reliance on life imprisonment for a wide range of offenses has resulted in soaring numbers of older, incarcerated people trapped in prison until death. The costs are enormous, simultaneously draining state resources and impacting the ability of the Alabama Department of Corrections (ADOC) to effectively manage prisons. The sheer increase in the numbers of older, incarcerated people is stunning: In 1972, there were 181 individuals over the age of 50 in Alabama's prisons. That number now exceeds 6,750.This report seeks to determine just how much Alabama's rapidly aging prison population correlates with increases in the Department of Correction's financial burdens and systemic strain. Understanding the unsustainable nature of Alabama's aging prison population—and how the situation has reached a boiling point— exposes the necessity of comprehensive short and long term reform. Without reform, current trends indicate the uncontrollable expense of punishing thousands of people until they die will have severe consequences both for state budgets and prison safety.

How Discrimination in Health Care Affects Older Americans, and What Health Systems and Providers Can Do

April 21, 2022

Racial and ethnic discrimination has a significant impact on the health of people of color, affecting mental health and contributing to high blood pressure, negative health behaviors, and early aging. For Black older adults, the cumulative effects of race-related stress experienced over the course of a life can increase the risk for mental and physical health problems.In health care settings, experiences of discrimination can include providers dismissing a patient's symptoms or health concerns, offering different treatment based on a patient's type of insurance, or not providing care in a patient's preferred language.We analyzed findings from the Commonwealth Fund 2021 International Health Policy Survey of Older Adults to examine experiences of racial discrimination in health care settings among Latinx/Hispanic and Black older adults. (See "How We Conducted This Study" for more details.) To provide some cross-national context, we first detail the extent to which older adults in 11 high-income countries believe their national health system treats people unfairly because of race or ethnicity. We then look more in-depth at the United States and report on older Americans' experiences of discrimination and the consequences of health providers' unfair or dismissive treatment. Finally, we consider steps that U.S. health system leaders, health care educators, policymakers, and others can take to address discrimination and dismantle systemic racism in health care.

Guide to Insurance in Contracting

April 23, 2021

The Guide to Insurance in Contracting provides general guidance on a variety of insurance options for community-based organizations (CBOs) seeking or engaged in contracting work with health care entities. This new resource guide helps get readers started with the basics of health care contracting insurance.This resource is part of the Aging and Disability Business Institute's multi-part Contracting Toolkit. Additional resource guides can be accessed via their website.Click "Download" to access this resource.

Paying Family Caregivers to Provide Care during the Pandemic- and Beyond

March 5, 2021

Medicaid is the primary funder of long-term services and supports (LTSS) in the United States. It provides those services and supports either through institutional care (i.e., nursing home care) or home- and community-based services (HCBS). This report explains that one cost-effective HCBS option with multiple advantages is to pay family members to provide care for older people and adults with physical disabilities.Pandemic Phenomenon: Long-Term Care Concerns MagnifiedThe COVID-19 outbreak has intensified longstanding problems in long-term care. Nursing homes were among the first COVID-19 "hotspots" in the United States, with their residents' death rates far exceeding the general population. Meanwhile, the pandemic has only exacerbated nursing homes' challenges related to social isolation, and the physical and mental harms from isolation are well documented. The COVID-19 pandemic has also exacerbated the ongoing nationwide shortage of direct care workers and high turnover within the industry.What Gets in the Way of Enabling a Promising ResourceIn spite of the advantages of providing pay for family caregivers, the concept has met certain barriers. One of the most common restrictions states impose is that a person may not hire his or her spouse as a paid caregiver, with the rationale that caring for one another is a responsibility inherent in the spousal relationship. In a pandemic environment, of course, this restriction can force spousal caregivers to work outside the house and bring in an outside caregiver, both of which raise the risk of infection. Concerns about family members committing fraud by billing for hours not worked has also motivated restrictions even as fraud is, in fact, extremely rare.Paying Family Caregivers Benefits Families and TaxpayersFamily caregiving already serves a critical role in mitigating the growing strain on the LTSS system, in part by expanding the caregiver pool. As Americans continue to live longer, family members are providing ever more complex care at home, often for longer periods of time. A family caregiver's responsibility to provide that high level of care can make it difficult or even impossible for them to maintain another job. Therefore, paid family caregiving answers multiple needs:The person who needs care can age at home, which is the preference for the vast majority of people who need LTSS.The family caregiver earns modest income, mitigating the impact of lost job hours.It is a lifeline to families who cannot otherwise afford to care for their family member.Costs are kept lower. One analysis found the average monthly cost for self-directed care was $1,774 in 2019, compared to $6,175 for a semi-private nursing home room.Costly institutionalization is delayed or avoided entirely.ConclusionWhen COVID-19 cases began mounting during the spring of 2020, state Medicaid agencies lifted some restrictions and allowed more family members to be hired and paid as caregivers. States should now consider implementing permanent policies that encourage and facilitate paid family caregiving, and invest in support services for caregivers. Current Medicaid reimbursement rates are not sufficient to attract enough direct care workers into the professional home care workforce, and COVID-19-related budget shortfalls and balanced budget requirements mean reimbursement rates will not be raised any time soon.Click "Download" to access this resource.

Fast Facts: A Tale of Three Retirement Lifestyles

March 4, 2021

Spending in retirement is an increasingly important area of focus of the retirement industry, plan sponsors, and policymakers as more individuals enter retirement. Indeed, in the third quarter of 2020, about 28.6 million Baby Boomers - those born between 1946 and 1964 - reported that they were out of the labor force due to retirement. Yet not enough is understood about how retirees spend their money and, just as importantly, why they spend the way they do.In its Issue Brief, "Why Do People Spend the Way They Do in Retirement? Findings From EBRI's Spending in Retirement Survey," the Employee Benefit Research Institute (EBRI) reported the spending habits and situation of 2,000 individuals ages 62 to 75 at and during retirement. Three types of retirees in particular stood out: (1) highly indebted retirees who described their debt as unmanageable or even crushing; (2) long-term secure retirees, or those retirees who reported they had long-term care insurance; and (3) full-nester retirees, or those reporting that they had at least one child at home with them. These three groups are highly distinct from one another and paint a portrait of starkly different retirement lifestyles depending on these circumstances.EBRI was able to fund development of this research thanks to a generous grant from RRF Foundation for Aging.Click "Download" to read the summary of EBRI's research.

Issue Brief: Low-Income Older Adults Face Unaffordable Rents, Driving Housing Instability and Homelessness

February 16, 2021

Older adults are at the center of the nation's housing affordability and homelessness crisis. Older adult renters are more likely to pay a large proportion of their income for rent than the population as a whole, and this extreme rental cost burden places them at increased risk of housing instability and homelessness. In many parts of the U.S., low-income older adults are the fastest growing segment of the homeless population. Due to discrimination and higher rates of poverty, Black and Latinx older renter households are more likely than white older renters to face severe rent burdens. The pandemic has made the situation worse. Justice in Aging and the National Low-Income Housing Coalition co-authored a new issue brief, Low-Income Older Adults Face Unaffordable Rents, Driving Housing Instability and Homelessness, that dives into the data behind what's driving this crisis and offers policy solutions that will help ensure no older adult is pushed into homelessness.  Solutions include investing in more affordable, accessible housing for seniors; increasing income supports for lower-income seniors; and making health care more affordable and accessible. These investments, combined with integrating affordable housing with community-based health and social supports, will go a long way toward solving the problem. Click "Download" to access this resource.

Disrupt Disparities: Challenges & Solutions for 50+ Illinoisans of Color

February 8, 2021

Illinois is at a turning point. While the total state population is shrinking, it continues to age and diversify. More than 34 percent of the state population of Illinois is above the age of 50 and continues to age. Of Illinoisans above the age of 50, more than a third are African American/Black, Hispanic/Latino, or Asian American/Pacific Islander. In large population centers, such as suburban Cook County and Chicago, one-half to two-thirds of older adults are of color.Yet even with these changing demographics, there has been little study of the experiences and needs of African American/Black, Hispanic/Latino, and Asian American/Pacific Islander older adults in Illinois and the public policy responses to the needs and challenges of these communities. With the onset of the COVID-19 pandemic, and the devasting effects of the pandemic on older adults in particular, the need to focus on these older communities of color is more paramount than ever.Given these changing demographics and growing challenges, AARP, in partnership with collaborating organizations Asian Americans Advancing Justice - Chicago, Chicago Urban League and The Resurrection Project, engaged Loyola University Chicago's Center for Urban Research & Learning to conduct a literature review and analysis of the existing research and data focused on African American/Black, Hispanic/Latino, and Asian American/Pacific Islander older adults in Illinois.This resulting report focuses on the issues of economic security, health and digital connectivity for older adults of color in communities. The authors have outlined first-step policy recommendations that should be taken at the state and local level to begin to address these challenges for older adults of color.Click "Download" to access this resource.

From Momentum to Movement: Developing a Unified Strategy to Support Family Caregivers Across the Nation

February 1, 2021

The National Alliance for Caregiving (NAC) presents From Momentum to Movement: Developing a Unified Strategy to Support Family Caregivers Across the Nation.This report is aligned with NAC's mission of building partnerships in advocacy that improve the lives of family caregivers. In 2019, NAC convened its Annual Conference of Caregiver Advocates to explore the need for a unified strategy to address family caregiving as a public health issue. By amplifying feedback from that conference and engaging the collective expertise of the National Caregiver Advocacy Collaborative, as well as several advocates involved with state caregiving plans at various stages of development, NAC continues its mission of building out partnerships to advance the goal of a unified caregiving strategy to support family caregivers across the nation.From Momentum to Movement represents the first iteration of a living document and compilation of resources to help guide advocates in developing statewide caregiving strategies that address community-level needs. This report presents a strategic process to foster the development of actionable goals in new state plans. It also includes core policy recommendations in person-centered domains intended to coordinate alignment across key global, national, and state-level priorities and to strengthen movement toward a robust, unified caregiving strategy for caregivers across the lifespan.Click "Download" to access this resource

A Collaborative Report on the Aging Undocumented Population of Illinois

December 30, 2020

Undocumented individuals face pervasive and structural barriers due to their immigration status that block them from the services older adults depend on to successfully age in place. Meanwhile, Illinois has among the highest populations of U.S. undocumented individuals (400,000+). The movement of the population into senior years has substantial implications for public systems of health, health care and social services throughout the state.This report explores how the undocumented population in Illinois will continue to grow by 2030, as well as discuss in depth the implications of that data.As the U.S. population ages, and the older adult population diversifies ethnically, racially, linguistically and economically, this will also include the aging of the undocumented community. This report strives to take into account the aging of the undocumented community, specifically when we discuss the future of aging and health care services.Click "Download" to access this resource.

The Gap Remains: Social Security Benefits Continue to Fall Short of Covering Basic Cost of Living for Older Americans, 2015-2020

November 1, 2020

Older Americans rely heavily on Social Security to support an independent lifestyle. Recent estimates suggest that among adults aged 65 years or older, more than half rely on Social Security for at least 50% of their family income, while nearly a quarter depend on Social Security for 90% or more of their family income.Despite this substantial reliance on Social Security among older adults, Social Security benefits fall short of what is required to cover a basic cost of living across the United States, according to new estimates based on the Elder Index, a county-by-county measure of the income older adults need to secure an independent lifestyle. Nationally, the average Social Security benefit fulfills just 70% of basic living expenses of housing, food, transportation, and health care for a single renter in 2020, and 82% for an older couple.Each September, a cost of living adjustment (COLA) is determined for Social Security benefits, based on the Consumer Price Index (CPI-W), and incorporated into the coming year's benefit adjustment. Typically, the COLA results in a modest increase in benefits, although benefit adjustments have been set at zero three times since 2009. The COLAs used for benefit adjustment do not account for expenses that disproportionately impact older adults, such as medical care, nor do they incorporate differences in costs of living across geographic locations.In this report, the authors document spatial and temporal aspects of Social Security benefits' coverage of older Americans' cost of living by comparing average Social Security benefits to the Elder Index in 2015 and 2020. First, they briefly introduce the Elder Index and how it is calculated to measure cost of living specific to older adults. Second, they document the extent to which average Social Security benefits cover cost of living for older adults at the national and county levels in 2020. Third, they compare patterns of coverage between 2015 and 2020, identifying states where Social Security benefits' coverage of the Elder Index has increased, stayed flat, or decreased over time. The report concludes by discussing policy implications.Click 'Download' to access this resource

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