Taking a bath, doing the dishes, fixing breakfast, shopping for groceries, making the bed, folding the laundry — these are just some of the tasks that many of us take for granted. But, as we age, these seemingly mundane yet essential responsibilities can become cumbersome and, for some, impossible.
At some point, nearly 70 percent of Americans will require long-term services and supports to manage the basics of day-to-day life, such as bathing, dressing and cooking. As the national association representing agencies that do the important work of connecting older adults and their caregivers to many of these vital services, we are well aware of the fact that most Americans want to age in their homes and communities with health, dignity and independence. But our country has a long way to go toward realizing that goal for older adults who can no longer manage life’s core tasks without support.
Among developed nations, the United States spends the most on health care but the least on the social services that might make it easier for older adults to continue living at home. This gap presents an unforeseen obstacle for older adults and caregivers as they navigate the winding, and sometimes rocky, road of maintaining independence and health as they age.
Researchers and many in the health care community are increasingly recognizing that supportive services, like those provided by Area Agencies on Aging, that address social factors — safe housing, access to healthy meals, the availability of transportation options, to name a few — can play a tremendous role in improving older adults’ health and quality of life.
Unfortunately, most adults are either insufficiently prepared to pay for these services or mistakenly think that these supports will automatically kick in at age 65 when they join the ranks of the more than 56 million Medicare beneficiaries. But Medicare — the flagship federal health care program providing hospital and medical benefits to people 65 and older — essentially does not cover long-term services and supports. This leaves far too many families struggling to support their older loved ones’ health and daily needs, resulting in caregiver burnout, financial strain and unnecessary health care costs — plus not enough funding for community supports that could ease those burdens. The only health program that pays for social supports to some degree is Medicaid — which requires older adults to spend down their assets to be eligible for this vital coverage.
It’s said that health happens at home — and we agree. The best patient care possible in the doctor’s office won’t matter if an older adult with multiple chronic conditions goes home to an empty refrigerator, no heat or no transportation to get to a follow-up visit.
Fortunately, there are opportunities to fill in these gaps for millions of older Americans and their caregivers. For one, our government and health care leaders must recognize that addressing the social factors that can influence health and well-being, called the social determinants of health, will result in improved health outcomes.
The good news is that we already have an established and trusted national network of home and community-based supports and services that is committed to boosting the health, independence and dignity of older adults, people with disabilities and their caregivers. This Aging Network has a 50-year history of helping individuals successfully age at home and in the community. But, for the most part, our current health care system hasn’t provided funding that would enable the Aging Network and other community organizations to provide many of the critical support services older adults need.
Policymakers are starting to recognize, however, that since Medicare is the primary provider of health care to older Americans, it should be allowed to cover some of the social services — such as nutrition, transportation and assistance in the home — that could address the social determinants of health, reduce taxpayer costs and improve health outcomes for millions of older Americans. The Aging Network and local Area Agencies on Aging are ideal partners in current and future initiatives to ensure these needs are met.
Fortunately, we are beginning to make strides toward expanding Medicare policy to address the health needs that happen at home and in the community — but we have a long way to go. Two recent changes to Medicare have expanded the ability of some Medicare insurance companies to provide limited amounts of health-related social services and supports for some beneficiaries with complex health conditions. While a step in the right direction, access to these services must be significantly expanded to adequately meet the increasing need.
The country’s aging population and the need for long-term care are growing faster than the country can implement solutions. Now is the time for policy leaders, lawmakers and advocates to insist on expanding Medicare to address the social determinants of health and the critical social services needs that enable people to age successfully where they want to — at home and in the community.
• Sandy Markwood is CEO of the National Association of Area Agencies on Aging. For more information, please visit n4a.org and @n4aACTION.
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