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Seniorgram: Sending a Message on Senior Issues

“Who Will Care?” Report speaks to workforce needs

RoseannMartocciaHeadshotExecutive Director Roseann MartocciaThe Providers’ Council, the Donahue Institute at UMass and the Public Policy Center at UMass Dartmouth collaborated on the recently released report, “Who Will Care? The Workforce Crisis in Human Services.” The report seeks to better understand the growing workforce needs in the human services sector and examine potential solutions to the issue. Growth in demographic cohorts, such as elders, has contributed to increasing workforce needs in the direct work force, skilled professionals as well as licensed and clinical staff.

From 2015 to 2025, the working age populations age 20-64 in Mass. is projected to decrease by 40,000. This leads labor force and employment projections to suggest that the workforce in Mass. will fall short of what is needed. Labor market forecasts the growth in the human services industry will continue over the coming decade. These jobs will include new healthcare and social assistance jobs. Human services accounts for 27% of all health care and social assistance jobs. They include healthcare social workers, mental health counselors as well as child, family and school social workers.

Health and human services employers are already finding it difficult to fill both direct support and clinical positions within their organizations. A stable workforce is necessary to:

  • preserve consistent therapeutic relationships with clients, consumers and families;
  • meet contractual and/or compliance obligations; and
  • provide staff with necessary professional development and supports to foster job satisfaction.

The report goes into great detail regarding industry growth, challenges in filling positions and the impact on consumers and families as well as how to address these workforce issues. The report concludes with the following recommendations:

  • the Commonwealth should serve as a champion for the community based human services industry;
  • a clear career path should be developed to attract millennials into the industry;
  • provide sufficient funding so that employers can offer salaries competitive to public sector employees performing similar work;
  • fund government mandates, such as fingerprint screenings;
  • support loan forgiveness and tuition remission programs for workers; and
  • establish appropriate guidelines for organizations to hire and train immigrant workers through work or training visa programs.

As we know, life circumstances place individuals in need of care for a variety of reasons. Care providers must be a priority for policy makers, lawmakers and employers so we can collectively meet the needs of those who need care along with their families. To read the full report, click here.

Advocate to meet the needs of elders or the numbers won’t add up

Roseann MartocciaRoseann Martoccia, Executive DirectorPeople over the age of 60 will be 22% of the state’s population by 2020. At of the end of 2016, Massachusetts citizens 60 and older outnumbered those residents age 19 and under. While people of all ages use long-term services and supports (LTSS) to live independently in the setting of their choice, almost half of the people in Massachusetts using LTSS are elders. The population in our state is projected to age rapidly, with the rate of growth for those 65+ to increase by 46% over the next 20 years. These numbers are dramatic and will increase the need for LTSS and the demand on the workforce. In addition, people with disabilities and chronic conditions are living longer.

The Administration’s plan (known as House 1) for the FY18 budget is now making its way through the legislative process in the House and Senate. In the current year (FY17), the legislature appropriated $3.7 million to end Home Care waiting lists. The enrollment in Home Care and in Enhanced Community Options and the reports of Elder Protective Services continue to increase to meet demand. All consumers enrolled in Enhanced Community Options are living at home and meet the clinical criteria for nursing facility placement.

Based on the demographics, we know the demand for home- and community-based services will increase in the years ahead. We need to fund accounts adequately to meet the need and use this cost-effective method to support elders and family caregivers. The Home Care regulations have been updated effective January 2017. There has been an expansion of the definition of dementia allowing for persons over 60 as well as those under 60 with a physician’s documented diagnosis of Alzheimer’s, a related disorder, or other dementia. In addition, persons over 60 who meet eligibility requirements but exceed the income eligibility can avail themselves of services on a sliding fee basis. Both of these changes are positive, but appropriations must keep pace in the following areas:

  • Home Care, Enhanced Community Options, and Care Management: House 1 provides no funding to accommodate the expected 2.5% growth in enrollment and the expanded eligibility for enrollment of persons over income.
  • Elder Protective Services: An 8% increase in Protective Services reports and activities are anticipated, and there is a waiting list for Money Management services (bill paying and Rep Payee services) along with the need for additional guardianship slots. None of these are funded in House 1.
  • Enough Pay to Stay: The workforce needed to keep pace with the number of elders needing care and oversight at home is not adequately funded. This new initiative is a top priority and essential to have the capacity to care for those needing LTSS.

Contact your legislators to ask them to support changes to House 1 to support the needs of a growing demographic of elders and people with disabilities.

What lies ahead for Medicare and Medicaid?

Executive Director Roseann MartocciaExecutive Director Roseann MartocciaDuring the week of January 16, lawmakers took the first steps toward repealing the Patient Protection and Affordable Care Act (ACA), a budget resolution that included instructions to legislative committees to develop proposals to rescind key parts of the law. 

While the first steps of repealing the ACA have been taken, the aspects of the law that would be replaced are not clear nor are the specifics of replacement provisions.  It is a time of more questions than answers.

What would a proposal do to ensure that the pre-Medicare population (age 54-64) can access affordable and adequate health care insurance to protect their health now and save Medicare and Medicare LTSS expenditures later?

Will the Medicare wellness benefit, drug benefits and savings proposals in the ACA continue uninterrupted? 

The new administration wants to “modernize Medicare.” This phrase refers to proposals like “premium support” (giving people a voucher) and raising the age of Medicare eligibility. Congress has previously proposed giving seniors a check and a list of private healthcare plans. This approach to Medicare seeks to reduce the growth in Medicare spending by increasing competition among private health plans and providing a stronger incentive for beneficiaries to be cost-conscious in their plan selection. 

There are also significant implications to the states (and people who are enrolled) if efforts to convert Medicaid, the largest health plan for low-income people of all ages, from an individual entitlement into a capped block grant move forward. The policy approach proposed by the new administration is to offer states a choice between a Medicaid per capita allotment or a capped allocation. There are 1.9 million people on Medicaid (MassHealth) in Massachusetts. The commonwealth is one of the states that exercised its option under the Affordable Care Act (ACA) to cover most residents with incomes up to 138 percent of the federal poverty level. Five hundred thousand new enrollees joined the program between 2013 and 2016.

MassHealth represents nearly 40 percent of the state’s budget ($13.7 billion in 2015), and brings in more than 90 percent of the federal funds received by the state ($9.79 billion). MassHealth is the essential health safety net for low-income state residents, providing health care for more than one in four Massachusetts residents. If the ACA is repealed, half a million Baystate residents could lose their MassHealth card.

It is essential to advocate to our lawmakers and to other legislators across the nation to protect the health and financial security of elders, people with disabilities, and their families.

There is national effort to get people to call their US senators regarding the need to have an adequate plan in place if the Affordable Care Act is repealed, which you can learn about at www.savemycare.org. Pass this website along to your friends and families living in other states so that they can participate in the effort as well.  

What lies ahead for Medicare and Medicaid?

What does retirement mean today?

RoseannMartocciaHeadshotExecutive Director Roseann MartocciaIn a 2014 Huffington Post article entitled. “It’s Time to Retire our Definition of Retirement,” Arianna Huffington wrote:

“The same principles that allow us to thrive in our daily work lives can also help us thrive in retirement, or whatever we call it. Just as a productive workday depends on how we prepare ourselves for it (for example, by getting enough sleep and taking time to recharge ourselves in our off-hours), a productive, meaningful and purposeful retirement depends on what we put into it.”

I had the pleasure of attending the Franklin County Chamber of Commerce Citizen of the Year event in December where Ann Hamilton was honored as the 2016 recipient and for her service as Executive Director of the Chamber of Commerce. I was struck by Ann’s reflections on retirement as a time of transition and both looking back and moving forward. She called upon the words of Ellen Goodman in her final column which appeared in The Washington Post on January 1, 2010:

“Looking backward and forward. I belong to a generation that has transformed our culture. We've been the change agents for civil rights, women's rights, gay rights. Now, we find ourselves on the cutting edge of another huge social change. This time, it's the longevity revolution. Ours is the first generation to collectively cross the demarcation line of senior citizenship with actuarial tables on our side. 

"‘Senior citizen’ is now a single demographic name tag that includes those who fought in World War II and those who were born in World War II. We don't have a label yet to describe the early, active aging. But many of us are pausing to recalculate the purpose of a longer life. We are reinventing ourselves and society's expectations, just as we have throughout our lives.”

The reality of retirement has changed for many reasons, such as the mix of part-time work, volunteerism, caring for younger and/or older members of one’s family and exploring new adventures near and far from home. These are common responses when one asks, “What are you doing now that you have retired?” Engagement is very important, and lifelong learning opportunities present themselves when you have some newfound time on your hands. Regular exercise and being outdoors are also ways to be with others or enjoy productive time on your own. There is no cookie-cutter approach to “retirement” these days. Financial security and good health are certainly factors that can make retirement easier or more complex if one has limitations on resources or their health.

Ellen Goodman also put forth four keys to a successful transition when work is not such a “full-time job”: 

  1. Embrace change imaginatively 
  2. Have an optimistic outlook
  3. Have faith in yourself 
  4. Find and engage with a supportive social network beyond the worksite

Impact of hearing loss on the whole person

RoseannMartocciaHeadshotRoseann Martoccia, Executive Director, LifePathA 25-year study of self-reported hearing loss in France describes how hearing loss can impact a person, including memory loss and cognitive decline. The study began in 1990 and included 3,670 participants. This research was designed to study brain aging, and the 25-year follow up with the participants was used to assess the relationship between hearing loss and long-term, age-related, cognitive decline.

Hearing loss is the third most common chronic health condition affecting older people. It is estimated that 30% of older adults age 65 and older have some degree of hearing loss and approximately 70% to 90% of persons 85 and older have hearing loss. Those with hearing loss often experience social isolation and depressive symptoms. Evidence also demonstrates that older adults with hearing loss have poorer cognitive performance. In two longitudinal studies, hearing loss and cognitive decline were associated over six years of follow-up. While the high prevalence of hearing loss and its consequences on health outcomes is commonly understood, hearing loss is largely underdiagnosed and therefore undertreated. Nearly two-thirds of older persons with impaired hearing do not use hearing aids.

The study used a short questionnaire at the outset with each person to establish a baseline, and the participants were evaluated at home 11 times over the 25-year period after the initial visit. Participants were asked about their hearing trouble, if they had trouble following conversations with more than one person participating, as well as how background noise impacted their ability to hear. Some had hearing aids and some did not. The evaluations also assessed cognitive performance and complaints, functional ability, and symptoms of depression. While the study design used observational results that were self-reported, its strengths include the length of time the study followed participants and the cohort of a large number of people who were randomly selected.

The study concludes that hearing loss is associated with accelerated cognitive decline and that hearing aid use reduces such cognitive decline. While the progression of hearing loss is an individual process, the study underscores the importance of addressing one’s hearing as part of overall physical health and well-being. Talk about hearing issues with your practitioner so any issues can be properly evaluated by clinical specialists, diagnosed, and treated appropriately. As hearing loss impacts social isolation, take a proactive approach to addressing hearing loss. As hearing aids are costly, it is important to understand the type of hearing loss you have and to be a smart consumer in any purchases of assistive device to improve hearing.

For more consumer information regarding hearing loss and hearing aids, go to: www.mass.gov/eohhs/gov/departments/mcdhh/programs/hearing-dogs/hearing-aids.html