How many government services will the elderly lose?

Politics, Money, News

The oldest of the Baby Boomers—that giant generation of Americans born between 1946 and 1964—turn 71 this year, and the percentage of the US population 60 or older continues to grow. While many older Americans have well-planned estates and will enjoy a relatively comfortable retirement, many others will struggle with health and economic worries. For that latter group, the last year has been a rollercoaster ride, with highs and lows driven largely by a rapidly changing political environment.

Last April, with Barack Obama in office, Congress renewed the Older Americans Act (OAA). The OAA was first passed in 1965 to provide social services for Americans 60 and older, helping them remain active and healthy. It not only helps an estimated 11 million seniors by providing much-needed services, but also assists their caregivers who rely on many of these services for their loved ones.

Now, however, the new budget proposed by President Trump has imperiled a number of that Act’s provisions, most famously, the components that pertain to the “Meals on Wheels” program. But as the GOP-led government continues searching for ways to slash spending, the scope and effectiveness of the Act in general will likely be greatly diminished well beyond just that specific program.

Provisions of the Act

The OAA has seven different sections, called titles, which specify the various programs and agencies involved. Titles I and II set out the objectives and establish the Administration on Aging (AoA) within the Department of Health and Human Services to coordinate most of the programs.  The AoA focuses on providing home and community services to seniors to promote their well-being and help them live independently in their homes and communities.

State programs for home care and nutrition

Title III creates grants that enable states to fund local programs. Each state allocates the funding among its own programs. In 2015, total federal funding was $1.878 billion (it sounds like a lot, but compare it to the $236 billion Medicaid gets), and the numbers have remained relatively flat over the past decade, despite the rise in the senior population.

The programs that fall under Title III are some of the most important for seniors. They include case management, the aforementioned Meals on Wheels, transportation, homemaker services, day care, and prevention and management of chronic health conditions. The programs also cover some of the cost of meals offered at senior centers and provide nutrition counseling, helping to address hunger and malnutrition among the elderly.

More than 85% of the seniors receiving these services said that the programs helped them remain in their own homes.  One study showed that states which invest in these services have fewer nursing home residents—a real plus, since most people would prefer to “age in place,” living in their own home rather than an institutional facility. In fact, the version of the OAA renewed in 2016 provides for the development of a tool that will allow older Americans and their caregivers to evaluate and choose in-home and community services.

The services under this section of the Act ease the burden of family caregivers. Additional services through the National Family Caregiver Support Program are funded specifically to help caregivers, including referral programs, respite care for when caregivers need a break, and counseling services.

Employment assistance for seniors

Many seniors need assistance finding work. Title V established the Senior Community Service Employment Program (SCSEP), which is managed by the Department of Labor and assists low-income or unemployed people age 55 or older find part-time work. This portion of the Act funds job training and employment opportunities for seniors to work at libraries, schools, day care centers, hospitals, and senior centers. Participants earn the state, federal, or local minimum wage (whichever is highest). Thanks to this provision, more than a million people over age 55 have found employment.

Protective services and other benefits

Title VII establishes programs to protect the rights of older Americans by establishing the Long-Term Care Ombudsman Program, which provides advocates for residents of nursing homes and assisted living communities. The advocates hear complaints about care in these facilities and work to resolve the problems.

“The standards to care facilities vary widely state-by-state,” explains Chris Davis, attorney at the Davis Law Group in Seattle. “For example, there are many smaller homes, some of which lack a real system of checks-and-balances.” Residents or family members can reach out to their local ombudsman with concerns, problems, and questions about care in a facility.

Title VI, meanwhile, provides services for Native Americans and tribal organizations and sets out standards for grants to tribes. This section also provides nutrition services for older Native Americans. And Title IV sets up financial support for research, training, and demonstration projects so that advancements in knowledge and innovative ideas can be furthered within the field of aging.

The Trump Administration’s budget proposal includes a $15.1 billion cut (or 17.9% of the total budget) to the Department of Health and Human Services, and while there are no specifics in terms of how that cut would affect the OAA, it would appear the pendulum has very quickly swung back against federal help for elderly and disabled Americans. It’s anyone’s guess how many of the above services and provisions will survive in the current political climate.