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Seniorgram: Sending a Message on Senior Issues

The growing elder demographic, better access to home care and what lies ahead

Roseann MartocciaRoseann MartocciaBased on census projections, it is estimated that 87,882 elders in Massachusetts are below 300% of poverty and have a disability. Currently, home care programs in the Commonwealth serve just over 47% of these elders through enrollment in Home Care, Enhanced Care Services and Choices. A goal for these three programs going forward is to reach and service a greater percentage of elders who need long-term supports and services and are not eligible for MassHealth. The two primary reasons are to keep them living independently in the community and to help them maintain their economic security.

Living Below the Line: Economic Insecurity Among Massachusetts Elders’ describes the needs of elders and their financial situation to meet basic living expenses (food, housing and health care). The 2014 study was conducted by the MA Association of Older Americans and Wider Opportunities for Women, and it describes the income (adjusted by county and household size) that elders need to afford the basics without going into debt or needing financial assistance from public or other sources. The report goes on further to say that “elders having difficulty living independently due to poor health are most likely to have elevated health care costs, and are highly likely to lack economic security.” Nearly three-quarters of elders who have difficulty with self-care are defined as “economically insecure,” and seventy-one percent of elders reporting having trouble living independently are also economically insecure.

These are precisely the elders who lack disposable income to purchase care privately and many of whom may not have informal or family caregivers to pitch in to provide the care they need. An important first step was taken in 2017 through regulatory changes brought forth by the Executive Office of Elder Affairs. People with incomes up to approximately $49,000 a year are now able to enroll in home care programs using a sliding scale to pay for a portion of their care based on their income.

While we will continue to advocate for resources in our state to support elders and their families, the potential for reductions in Social Security and Medicare may also be on the horizon. According to a Forbes article published December 3, 2017, there is likelihood that these two income and health programs will be impacted. Reductions in these programs have the potential to achieve savings in what is expected to be an increased deficit. The timing of such budget debates and actions are expected in 2018 or 2019. The Office of Management and Budget (OMB) projects revenue loss to increase the deficit by $1 trillion or more in 2019. With the numbers growing, it’s time to provide access to services, care supports and shore up income security for elders.

Advocacy never stops – with gratitude to Al Norman

Al Norman has moved on from his position as executive director of Mass Home Care.  For three decades, Al’s advocacy for elders was a force that kept the consumer front and center in any debate, legislative matter or policy consideration. His work has positively impacted the lives of so many elders, people with disabilities and caregivers, and for this we send our heartfelt appreciation. Al’s advocacy will go on and for that we are grateful. We wish him the best in all that lies ahead.

Meanwhile, advocacy continues….

On December 15, House and Senate leaders announced a compromise on the chambers’ competing tax cut measures. The conferenced package has moved quickly, and on December 19 the House and Senate voted affirmatively.   

The final bill, while retaining the medical expense deduction as it is in current law, would still drive up the federal deficit by $1.5 trillion over ten years. Even with robust economic growth to offset some of that deficit spending, nonpartisan experts predict the bill will ultimately drive at least $1 trillion in deficits over ten years.

Elder advocates are deeply concerned about the tax reform measures given their effect on the federal deficit at a time when our nation is aging rapidly.

The FY 2018 budget resolution, which passed by both chambers this fall and is the mechanism by which tax cuts are moving so quickly, calls for more than $2.5 trillion in cuts to Medicaid, Medicare and other aging programs like the Older Americans Act – in the name of deficit reduction! Leaders in Congress and the White House have indicated that legislation to make those cuts is a primary goal for 2018.

In fact, unless Congress gets bipartisan support to waive “PAYGO” rules, passage of the tax cuts will force automatic cuts to Medicare and several other mandatory programs in January. While Congress has averted such cuts in the past, this situation is a reflection of the fact that the tax cut bill makes revenue and deficit choices that we believe put critical aging programs in jeopardy in the short and long term.

At the state level, the Senate passed a Health Care Reform bill in November.  It is expected that Health Care Reform will be taken up by the House over the winter and spring of 2018. The Senate bill includes a transfer of funds from Home Care when a Medicare/MassHealth member is enrolled in a SCO (managed care) plan. While consumer protections are included should a member wish to disenroll, we are concerned about reducing access to home care when the Commonwealth is aging rapidly. Stay tuned for the House version which will likely be influenced by what happens at the federal level as applies to Medicaid in the FFY18 budget when finalized.

What would tax reform mean for elders and caregivers?

Roseann MartocciaRoseann MartocciaWhile Congress has not passed a budget, the FY 2018 budget “plan” does set a framework to potentially make significant cuts to overall federal non-defense discretionary (NDD) programs, including OAA (Older Americans Act) and other federal mandatory programs, such as Medicaid and Medicare. The budget resolution itself doesn’t have force of law – Congress still must enact these cuts in future legislation.

Congress approved a plan that would allow the Senate Finance Committee and House Ways and Means Committee to craft tax proposals that could add up to $1.5 trillion to the federal deficit over the next ten years. The approved plan paves the way for – but does not immediately require – Congress to identify $5 trillion in spending cuts from NDD and mandatory programs over 10 years.

Specifically, the measure calls for $800 billion in overall cuts to NDD programs; a cut to NDD funding of this magnitude would erode overall funding for domestic discretionary programs. If lawmakers enact cuts this drastic, by FY 2027, NDD funding overall would fall nearly 30 percent below FY 2010 levels.

Additionally, the budget resolution calls for $1.3 trillion in Medicaid cuts by 2027, which would slash the program by more than 25 percent. These cuts exceed those in either the House or Senate ACA-repeal bills to cap Medicaid that the National Association of Area Agencies on Aging (n4a) opposed earlier this year. Given that the bulk of Medicaid spending provides essential health care and long-term services and supports to 16 million older adults and people with disabilities, States would be unable to absorb cost increases associated with a declining federal share of Medicaid spending, and would likely resort to cutting, wait-listing or otherwise restricting services for high-cost beneficiaries.

In addition to $473 billion to Medicare, which provides acute healthcare and hospice services to 57 million seniors and people with disabilities, $650 billion in cuts is slated for mandatory income-support programs, including Supplemental Security Income (SSI) and Supplemental Nutrition Assistance Program (SNAP) programs.

As the tax reform plans evolve, who benefits from them will be a major point of debate. Initial analysis indicates that high-income earners and corporations will be the primary beneficiaries of tax cuts. According to the Tax Policy Center, the proposed tax cuts would, over 10 years, direct 80 percent of the benefit to the top one percent of earners. Earners in the bottom 80 percent would receive only 13 percent of the benefit. Additionally, households making less than $75,000 annually would receive a tax benefit of roughly $200 per year.

While tax policy is not a common topic for advocates, it takes center stage when it will significantly impact federal domestic and mandatory programs serving older adults in their homes and communities.

This article was adapted from n4a Legislative Update, dated October 27, 2017.

Is it normal memory loss or Alzheimer’s?

RoseannMartocciaHeadshotRoseann MartocciaNovember is Alzheimer's Awareness Month. It is chilling to reflect on the fact that more than 3 million individuals in our country have Alzheimer's disease. According to a new report released by the Centers for Disease Control and Prevention (CDC), the US death rate from Alzheimer's disease increased by 55% for the 15 years from 1999 to 2014. However, the report results should not be cause for alarm.

"As the population ages and people are living longer due to other medical advances and improved health care, they are more likely to develop dementia like Alzheimer's. It's a disease of brain aging,” said Dr. Stuart Anfang, chief of Adult Psychiatry at Baystate Medical Center, who oversees the hospital's Memory Disorders Program.

The CDC report cites possible reasons for the increase in deaths: a growing older population, diagnosis at earlier stages, better reporting to doctors and involved practitioners along with fewer deaths from causes such as heart disease and stroke. 

Dr. Anfang offers five items to increase your understanding of the disease:

  1. Alzheimer's disease is the most common form of dementia. Other causes of dementia include cerebrovascular disease, Parkinson's disease, fronto-temporal dementia and certain infections. A thorough evaluation is important as some conditions are reversible and treatable such as depression, low thyroid levels, and certain vitamin deficiencies.
  2. Primary care physicians are a good place to start the evaluation process. This would include a physical, mental status evaluation, cognitive screening exam, initial lab tests and sometimes brain imaging using an MRI.
  3. There are no medications that can cure or reverse Alzheimer's. However, there are medications that can slow the progression of functional impairment and improve the quality of life.
  4. The prevalence of Alzheimer's dementia increase with age. Approximately 2-3% of 70 year olds have Alzheimer's while about 16% of 80 year olds have some degree of Alzheimer's dementia. The prevalence of Alzheimer's disease doubles for persons aged 85-90.
  5. Mild symptoms of cognitive loss are associated with normal aging or mild impairment. Not all memory loss is due to Alzheimer's or other dementia.

We salute the care and support provided by primary caregivers of persons with dementia. Alzheimer's requires the care, support and supervision by caregivers regardless of setting. Caregivers do so much and you are not alone. Reach out for the support you need to take care of yourself and get the help you need to care for your loved one. Contact LifePath for services designed to help caregivers, including dementia coaching, the Alzheimer's Music Project, dementia support group and in-home supports.

The Alzheimer's Association offers resources for caregivers as well.

“OTC” bill proposed to improve access to affordable hearing aids

Roseann MartocciaExecutive Director Roseann MartocciaMillions of people in Massachusetts and across the country experience hearing loss as they get older, but they can't get the hearing aids they need because of high costs and complicated regulations. The bipartisan Over-the-Counter Hearing Aid Act, which Senator Elizabeth Warren has reintroduced with Senators Chuck Grassley (R-Iowa), Johnny Isakson (R-Ga.), and Maggie Hassan (D-NH), would make hearing aids less expensive and easier to access. A companion bill has been filed by Representative Joe Kennedy III in the House. The bill has received endorsement from organizations such as AARP, the Gerontological Society of America and the Hearing Loss Association of America.

The bill would make certain types of hearing aids available over the counter (OTC) to Americans with mild to moderate hearing impairment.  It would also require the FDA to write regulations ensuring that this new category of OTC hearing aids meet the same high standards for safety, manufacturing protections and consumer labeling as all medical devices, which would provide consumers the option of an FDA regulated device at a lower cost.

Approximately 30 million Americans experience age-related hearing loss, including over half of adults between the ages of 70 to 79. However, only a small share of Americans with hearing loss (about 14%) use hearing aids, primarily due to the high cost. Hearing aids are not covered by Medicare or most private insurance plans. Out-of-pocket costs for one hearing aid can average $2,400, which is out of reach for many consumers.  People with low or moderate incomes are less likely to have access to hearing aids compared to individuals with higher incomes. 

Some of the key provisions of the Over the Counter Hearing Aid Act of 2017 include:

  • Certain types of hearing aids designed to assist adults with perceived mild to moderate hearing impairment would be available over the counter.
  • The requirement that consumers obtain a medical evaluation or sign a waiver of that examination in order to obtain an OTC hearing aid would be removed.
  • The FDA would be required to issue regulations related to safety and labeling requirements for this new category of OTC hearing aids.
  • The existing safety, labeling and manufacturing protections would be maintained and applied to OTC devices in order to ensure that OTC hearing aids would be held to the same high standards as other medical devices.
  • The FDA would be required to update the existing draft guidance on Personal Sound Amplification Products (PSAPs), consumer electronics products that may use similar technology to hearing aids but are intended for use by individuals with normal hearing.

Find a Fact Sheet on this bill here.

Click here to access a Consumer Guide to Hearing Aids published by AARP.