Policy alerts, briefs, letters & papers

Four articles provide an update of where the Older Americans Act (OAA) and the Aging Network stand in the face of demographic, economic, and health care issues. The first two cover the history of the legislative and budgetary developments of the network and report on a national survey of Area Agencies on Aging. The third summarizes political vagaries that network agencies encounter. The last advocates that civic engagement efforts must expand to cover disadvantaged and vulnerable older adults.

Many of the same social, health, and economic trends driving the development of home and community-based services in the U.S. are also present in Europe. A team of experts assembled by the World Health Organization presents evidence for the effectiveness of home care, shows how it can be improved, and explains the need for equitable access. It also explores the varied cultural and care contexts in Europe and provides suggestions on educating professionals and the public about these issues.

The author focuses on Medicaid and Medicare in offering healthcare reform suggestions. Both legislative and administrative actions are proposed regarding eligibility and enrollment, access to services, program management and delivery systems issues, and financing. Several options relate to HCBS, such as protecting spouses of the medically needy, expanding eligibility for SSI-related groups, and issuing further guidance on waiver waiting lists.

About 52 million people provided family caregiving worth about $375 billion in 2007. That amount exceeds Medicaid long-term care spending in each state. Caregiving services included in the estimate are personal care, help with everyday tasks, and health-related interventions. The document presents data nationally and by state and concludes with policy recommendations to support and sustain family caregivers.

In 2005, VT became the first state to commit to a federal Medicaid funding cap in exchange for expanded eligibility definitions and access to home and community-based services under a Section 1115 waiver. Case studies and interviews are used to present key findings from the program. Key design features are also presented. Finally, future issues within VT and other states that might emulate the program are discussed.

The Older Americans Act (OAA) gave rise to important HCBS programs such as the Choices for Independence initiative, ADRCs, and Nursing Home Diversion grants. Here is a concise summary of the legislation, its reauthorization in 2006, and data on the types of support provided under these programs, recipients, and expenditures.

This resource provides tools, contact information, and lessons learned from eight research projects that focused on providing a more stable and qualified workforce. These projects, including state demonstrations and applied research and evaluation programs, are part of the four-year, $15.5 million Better Jobs Better Care initiative. The report compiles the major findings, and the resource catalog provides surveys, policy analyses, training and assessment materials, and many more practical tools.

Visitability is a movement that seeks to eliminate certain barriers to aging independently by promoting accessible home design. The authors examine different types of visitability initiatives, challenges to implementation, and opportunities for further acceptance. The design parameters needed for visitability include a zero-step entrance, wide doorways, and at least one half bathroom on the main floor.

In the U.S., workers that experience disability onset are unlikely to receive return-to-work supports unless their disability is work-related or they have private disability coverage. The Pathways to Work program in the UK offers a range of supports that focus on preventing loss of work. After 18 months of evaluation, the data shows that it substantially improves outcomes. This brief offers lessons for U.S. policymakers that may pursue this strategy in the future.

This report provides a summary of how long-term services and supports (LTSS) are financed and describes factors that contribute to uncertainty of the future costs for LTSS, including changes in how LTSS will be delivered. Three projections of future LTSS spending for senior populations under different scenarios are offered. These scenarios differ based on projecting the number of people with varying functional limitations and the resulting need for varying degrees of LTSS.