The Older Americans Act Is Not Keeping Pace With Today’s Older Adults

COMMENTARY

In 1965, the Older Americans Act was a beacon of successful bipartisan legislation to address the social, economic and health needs of older Americans on a national level. Nearly 60 years later, the act has changed little, yet life for older adults and what it takes for them to thrive has changed significantly. 

This fall, the act is up for reauthorization — providing Congress an opportunity to give it a long overdue modernization to ensure it can meet the needs of older Americans today.

As the president and CEO of Grantmakers In Health, an adult caring for my aging mother, and someone who spent nearly a decade working at the Centers for Medicare and Medicaid Services, I’m familiar with the needs of older adults and the benefits of programs like Medicare, Medicaid and the Older Americans Act, as well as their shortcomings. 

Earlier this year, my 75-year-old very active and healthy mother fell off a ladder while taking down Christmas decorations. She lives alone and is proud of her independence, but the fall resulted in her needing round-the-clock care. My very independent mom needed support for bathing, dressing, eating and, quite frankly, living.

Like many people in her situation, my mother wanted to stay at home rather than enter a rehabilitation facility. So I moved in with her and have served as her primary caregiver since January, sharing some of the responsibilities with my two brothers.

My mom retired after working over 20 years in the federal government and has health insurance including Medicare. But not everything she needed was covered by insurance, including meals, bathing and dressing support, and transportation to doctor’s appointments. My family is fortunate — my brothers and I can care for our mother. We have the resources and a support network to help cover some of these shortfalls, but even we could use some support. 

The rate for a personal care attendant in my mom’s area is $38-$40 an hour. There are many people who don’t have caregivers or have needs that are more than their caregivers can handle. More importantly, it is unreasonable for our country to think one or two people can provide everything an older adult needs to live a fulfilling life. That’s where programs supported through the Older Americans Act are critical. 

My mom’s story is hardly rare — a fall has transformed the lives of many families across the country. It’s at that moment when we realize that the programs we believed were in place to help us actually fall short of meeting our needs.

My story is something my colleague Lindsay Goldman, CEO of Grantmakers In Aging, knows well. Over the last 20 years, she has worked for and partnered with programs funded by the Older Americans Act to help improve the health of older adults. Together, our two organizations are partnering to advocate for reauthorizing and strengthening the Older Americans Act.

For nearly 60 years, our government has operated under the assumption that the act is working well. But it is not.

The experiences and life expectancy of older Americans today are very different from the experiences in 1965, including the fact that the average life expectancy in the U.S. has increased by nearly 10 years — from an average life expectancy of 70 to 79 in recent years.

However, our nation’s chronological age isn’t the only number increasing. A recent study estimated that nearly 70% of older adults will need long-term care services, yet few can afford them.

While the poverty rate for older adults has declined since the Older Americans Act was passed, it recently increased for the first time, with older Americans as the only group who saw an increase. Economic and social disparities persist among older Americans, particularly for older women, people of low income, people of color and those residing in rural areas.

We have known for years that the Older Americans Act and programs such as Medicare and Medicaid struggle to meet the needs of older Americans in their most vulnerable moments. Recently, the U.S. Department of Agriculture reported that nearly 10% of households with an older adult struggled to provide enough food, a number that increased in recent years.

The Older Americans Act is about to turn 60. Instead of just reauthorizing it, what if we modernize it to meet the needs of older Americans today?

As Congress debates the future of the act, we recommend it consider several improvements to help optimize the health and well-being of older Americans today and in the future:

First, increase authorization levels for Older Americans Act programs and incentivize public-private partnerships. By increasing our investments and incentivizing public-private partnerships, we can minimize duplication, expand the number of older adults served, and provide services consistent with the needs of today’s older adults.

Second, we ask that Congress strengthen programs for caregivers — both paid and unpaid. My experience, as well as those of many others, shows that we need to invest in our care workforce. The Recognize, Assist, Include, Support, and Engage Family Caregivers Act of 2017, which addresses the diverse and complex issues faced by family caregivers, has expired and should be reauthorized as part of the Older Americans Act.

Third, address the specific needs of older Americans in rural communities. Rural communities have seen a decline in long-term care facilities, have chronic shortages of health care workers, and far fewer transportation options, including public transportation. Congress should increase flexibility in the Older Americans Act and pass the Addressing Social Isolation and Loneliness in Older Adults (SILO) Act (S. 3437 and H.R. 2692) to help community-based organizations better address social isolation and connect at-risk elders with the support they need, especially in rural communities.

And finally, we ask that Congress bolster interagency and cross-sectoral action on aging.

We recommend enacting the Strategic Plan on Aging Act, which would provide grants to states, territories and tribal organizations to create and implement Multi Sector Plans for Aging. These plans restructure state and local policies to create a coordinated system of high-quality care and support services that promote healthy aging. Congress should also use the OAA to authorize and fund the next White House Conference on Aging, which brings together a wide range of experts and stakeholders to generate policy recommendations on aging for the administration and Congress.   

We have a chance to make the most of the Older Americans Act as it turns 60. Let’s invest in strengthening and modernizing the act to optimize the health and well-being of older Americans today and well into our future. 

Cara James is president and CEO of Grantmakers in Health. She can be reached on LinkedIn.

Lindsay Goldman is CEO of Grantmakers in Aging. She can be reached on LinkedIn.