Policy Briefs

10. April 2015 12:57
by WHCOA Staff
83 Comments

Healthy Aging Policy Brief

10. April 2015 12:57 by WHCOA Staff | 83 Comments

Healthy Aging

Older Americans are calling for a shift in the way we think and talk about aging. Rather than focusing on the limitations of aging, older adults across the nation want to focus instead on the opportunities of aging. Older adults are seeking ways to maximize their physical, mental, and social well-being to remain independent and active as they age.

Healthy aging means living a long, productive, meaningful life and enjoying a high quality of life. Research has shown that older adults who adopt healthy behaviors, use preventive health services, and are involved with their family, friends, and communities, are healthier and more independent.

Americans are living longer and better than ever before thanks to major medical and public health advances and greater access to health care. Life expectancy at birth in the United States has reached a record high of 78.8 years. A 65 year-old man can expect to live another 17 years and a 65 year-old woman another 20 years. With increased longevity, older Americans have more time to engage in the workforce, in civic and volunteer activities, and in enriching their communities.

Older adults contribute to society through a variety of mechanisms, including paid work, volunteering, or providing unpaid care to family members. Eight out of ten adults age 65 to 74, and almost six in ten ages 75 and older, engage in at least one of these activities. One study estimated that the contributions of older adults through volunteering and unpaid family caregiving alone are worth more than $160 billion per year to our nation. Older Americans’ knowledge, experience, wisdom, and caring improve prospects for future generations.

Promoting Health and Preventing Disease and Injury

Older adults can do a number of things to promote good health and prevent disease and injury. Healthy behaviors such as exercising regularly, good nutrition, and getting recommended health screenings can contribute to longer, healthier lives. Even if someone has a chronic condition or a disability, these activities can improve health and quality of life.

Physical activity - Increasing physical activity is one of the best ways Americans can prevent disease and injury. It reduces the risk of many negative health outcomes in older adults, including early death, cardiovascular disease, stroke, diabetes, several forms of cancer, depression, cognitive decline, and falls. Physical activity reduces pain and improves function for those with arthritis and other chronic conditions. These are the reasons why the U.S. Department of Health and Human Services’ (HHS) Physical Activity Guidelines For Americans include recommendations for how older Americans can remain physically active; why the National Institutes of Health (NIH) initiated the Go4Life Campaign to help older Americans fit exercise and physical activity into their daily lives; and why the Administration for Community Living (ACL) supports evidence-based physical activity and fitness programs.

Nutrition - Studies show that a healthy diet in later years reduces the risk of osteoporosis, high blood pressure, heart diseases and certain cancers. NIH provides practical advice on nutrition for older adults in a resource called, “What’s On Your Plate? Smart Food Choices for Healthy Aging.” Recognizing the importance of nutrition and socialization to older adults, the President’s 2016 Budget includes nearly $904 million for HHS’ Administration for Community Living to support meals for older Americans, targeting at-risk populations. In addition, the Budget includes a proposal that would make it easier for low-income older Americans to access Supplemental Nutrition Assistance Program (SNAP) benefits.

Preventive health services - Screening and early treatment for diseases and behavioral health conditions are crucial to optimizing physical health and achieving healthy aging. The Center for Disease Control and Prevention’s Healthy Aging Program assists health professionals in early detection and prevention of diseases in older adults. The Affordable Care Act (ACA) recognizes the value of prevention and increases Medicare coverage of preventive services for older adults. In addition to an annual wellness visit to help a beneficiary maintain a personalized prevention plan to stay healthy and prevent disease and disability, Medicare now covers many preventive services and screenings with no copayments.

Managing chronic conditions - The Administration recognizes the need for a culture change in how we address chronic conditions (like arthritis, asthma, diabetes, and heart disease) in the United States and the need for a focus on supporting health. To this end, HHS has released “Multiple Chronic Conditions: A Strategic Framework” for the health care system to use in helping to improve the health status of individuals with multiple chronic conditions – including more than two-thirds of Medicare beneficiaries.

In addition, HHS is investing in research to advance our understanding of effective chronic disease self-management and sponsors evidence-based chronic disease self-management programs. Grants to state governments are providing tools and education to older adults so they can better manage chronic conditions, resulting in better health. The President’s 2016 Budget includes $8 million to continue these chronic disease self-management programs.

Preventing Injury - Falls are the leading cause of injuries, including hip fractures and head trauma, among older adults. Each year, one in three Americans over age 65 falls, and the fear of falling may lead older adults to limit their activities, which actually worsens mobility, increases their risk of falling, and detracts from quality of life. HHS supports grants to states and tribes to increase participation in evidence-based community programs to reduce falls and falls-risk among older adults and adults with disabilities. The President’s 2016 Budget includes $5 million to support the National Falls Prevention Resource Center and to support new community-based grants to grow and sustain evidence-based falls prevention interventions. The Centers for Disease Control and Prevention (CDC) has a multi-pronged approach to increase the level of engagement of, and partnership with, the medical community to integrate falls screening, assessments, and interventions into the clinical setting.

Optimizing Cognitive Health

While 70 percent of older adults report no cognitive difficulties, some serious threats to brain health increase with age. The risk for dementia increases as we age. Estimates are that 2.9 percent of people aged 65-74 have Alzheimer’s disease. This figure rises to 32.1 percent of people aged 85 and older. As many as 5.1 million adults over age 65 have Alzheimer’s disease, the most common form of dementia. Researchers expect this number to increase to 5.8 million in 2020. In collaboration with stakeholders and with the support of the Administration and Congress, HHS has developed a National Plan to Address Alzheimer’s Disease. Updated annually, this plan aims to prevent future cases of Alzheimer’s disease and better meet the needs of the millions of American families currently facing this disease.

With the resources requested for NIH in the FY 2016 President’s Budget, NIH estimates it could further expand Alzheimer’s research activities by another $51 million to a total of $638 million, a 55 percent increase since 2008. ACL’s Alzheimer's Disease Initiative fills gaps in “dementia-capable” long-term services and supports by providing high quality, person-centered services for people with Alzheimer’s disease and related dementias, and their caregivers. In addition, HHS provides consumer-friendly information through Alzheimers.gov to provide resources for people helping people with Alzheimer’s disease and related dementias.

The CDC is collaborating with the Alzheimer’s Association, NIH, and ACL to continue its Healthy Brain Initiative, which promotes cognitive functioning, addresses cognitive impairment for individuals living in the community, and helps meet the needs of care partners. NIH is supporting ongoing research on aging, including treating and preventing cognitive decline and dementia, and has identified instruments for clinicians and researchers to use in identifying cognitive decline. In December 2014, the Health Research and Services Administration announced availability of funding for dementia education within its Geriatric Workforce Enhancement Program.

Optimizing Behavioral Health

Behavioral health disorders such as depression and anxiety can cause distress and limit physical and social function as well as complicate the treatment of other medical conditions. Because of age-related changes in physiology and drug tolerance, older adults are also uniquely vulnerable to alcohol and prescription drug abuse, can be more sensitive to the effects of prescription drugs, and may experience interactions with their other medications or chronic conditions. Substance abuse affects up to 17 percent of older Americans, but health care providers often fail to recognize and treat substance use disorder in older adults.

Some behavioral health issues, such as suicide, disproportionately affect older Americans. According to the CDC, although people 65 and older represent 13.7 percent of the population, they accounted for 16.2 percent of suicide deaths in 2013. Suicide is preventable, and important resources are available to help older adults, aging and behavioral health service professionals, and family caregivers.

Unfortunately, older adults are less likely than younger adults to receive treatment for mental and substance use disorders. The Administration on Community Living recently began a new behavioral health education initiative focused on older adults in collaboration with the Substance Abuse and Mental Health Services Administration. This effort, coordinated by the National Council on Aging, includes webinars aimed at enhancing the ability of care networks to connect individuals and families with person-centered, consumer-directed behavioral health supports and services. Training topics include older adult behavioral health, suicide prevention, and substance abuse.

Maximizing Independence in Homes and Communities

Healthy aging means more than just managing and preventing disease and chronic conditions. It also means continuing to live a productive, meaningful life by having the option to stay in one’s home, remain engaged in the community, and maintain social well-being. Older adults may require other services and supports, including social and community services, and age-friendly communities, in order to maximize their independence.

It is important for older adults to have access to housing that is affordable, accessible and in a community where the ability to access health care, meet daily needs, and participate in social life is easy and safe. Many older adults, however, face reduced income and may find it more difficult to afford their existing housing. One third of older adults spend more than 30 percent of their income on housing. The President’s 2016 Budget includes $455 million for the Supportive Housing for the Elderly program (known as “Section 202”) within the Department of Housing and Urban Development (HUD) to support affordable housing with services such as cleaning, cooking, and transportation, for very low-income or frail older adults. The Budget also proposes adding $10 million to study how service coordinators, who are responsible to link residents in Section 202 housing to supportive services, support stable housing for older adults.

Age-friendly, livable communities help support independence for older adults by, for example, making curbs and sidewalks safer to navigate, and improving access to transportation, housing, retailers, health care providers and support services. Across the nation, local governments, Area Agencies on Aging (created by the federal Older Americans Act), and other community based organizations are leading efforts and leveraging federal, state and local resources to create age-friendly communities. Through the Partnership for Sustainable Communities, three federal agencies – HUD, Department of Transportation (DOT), and the Environmental Protection Agency – are helping communities nationwide improve access to affordable housing, increase transportation options, and lower transportation costs while protecting the environment. Additionally, CDC provides resources to support age-friendly community development, including tools to support older adult mobility planning.

Another critical aspect to maintaining independence is the continued ability to get around safely in one’s community. DOT has recently launched the Rides to Wellness Initiative. This initiative aims to make the transportation community a recognized partner with the health/wellness and medical communities to increase access to care, improve health outcomes, and reduce healthcare costs. In addition, older adults may experience driving challenges such as decreased vision and slower reflexes. In 2014, the Federal Highway Administration released the Handbook for Designing Roadways for the Aging Population to address these challenges. The National Highway Traffic Safety Administration is updating tools and resources for older driver safety, such as the Drive Well Toolkit and the Physician’s Guide to Assessing and Counseling Older Drivers.

Promoting Community and Civic Engagement

Older Americans have a lifetime of knowledge, talent, skills, experience, and wisdom enabling them to have powerful impacts in their communities. After years of hard work, many older adults enjoy taking on new roles to help others and giving back to future generations. More and more, older adults are choosing to use their experience and expertise to begin new careers to improve communities and the world.

The Senior Community Service Employment Program (SCSEP) is a community service and work-based training program for older workers. SCSEP participants work in a wide variety of non-profits and public facilities, including childca centers, senior centers, schools, and hospitals. These community service training opportunities promote self-sufficiency, provide assistance to organizations that benefit from increased civic engagement, and support communities. These assignments also can serve as a bridge to employment. In turn, regional economies and employers can benefit from an expanded pool of experienced, dependable labor in the local workforce.

Civic engagement, and in particular, volunteering, has been shown to improve physical and mental health, reduce risk of depression, and create greater life satisfaction by providing a sense of purpose and community. Older adults who volunteer may live longer and reap these benefits even more than younger volunteers do.

The Corporation for National and Community Service (CNCS) funds several programs designed to provide older Americans opportunities to remain engaged in their communities. Senior Corps currently links more than 360,000 older Americans to service opportunities. Their contributions of skills, knowledge, and experience make a real difference to individuals, nonprofits, and faith-based and other community organizations throughout the United States. These programs include the Foster Grandparents Program, which supports older adults in mentoring children, as well as the RSVP and Senior Companion Programs. This year, CNCS also began funding federally recognized Indian tribes to support older Indians’ participation in the Foster Grandparents Program and the Senior Companion Program.

Discussion Questions

The 2015 White House Conference on Aging (WHCOA) aims to foster a national conversation, and the questions listed below are designed to stimulate dialogue on healthy aging issues. The White House Conference on Aging will use the feedback received to continue to help shape outcomes of the 2015 White House Conference on Aging. Please provide your thoughts and ideas on our website. All comments will be displayed in the public conversation area of the WHCOA website.

What do older adults and their families need to manage their chronic conditions and to optimize their physical, cognitive, and behavioral health?
How can we ensure that older adults know about, and take advantage of, the preventive services available to them under Medicare?
How can we provide more opportunities for older adults to stay engaged and connected to their communities?
Are there current healthy aging programs or policies you think are the most or least effective or potentially duplicative?
What steps can help Americans to live safely and comfortably in their homes and communities as they age?
What additional actions could help ensure that older adults of all backgrounds can equally enjoy a long, productive, and healthy quality of life?

For questions about the policy briefs, please contact policy@whaging.gov.

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Comments (83) -

Paul Tatum

4/13/2015 11:51:57 AM

I think that a key component to having the best care possible when one has several chronic diseases is to be sure that care matches the goals and wishes of the patient. Excellent advance care planning and early provision of palliative care help make sure that patients receive health care that matches their needs and wants. Policy-makers can go a long way to improving the delivery of palliative care and advance care planning by having mature conversations that include the last years of life and dying as part of healthy aging.

Hugh R. Parry

Prevent Blindness

4/13/2015 1:33:55 PM

I applaud the White House Conference on Aging’s Healthy Aging Policy Brief and its shift to speaking to opportunities rather than limitations. A dialogue on healthy aging cannot be complete, however, without the inclusion of optimization of healthy vision and eye health. Eye disorders are the fifth leading chronic condition among those aged 65 years and over (affecting 23 percent of the population). Evidence further shows that people with vision impairment are more likely to experience other chronic conditions – diabetes, hearing impairment, heart problems, hypertension, join symptoms, low back pain, and stroke – as well as falls, injury, depression, social isolation, diminished health-related quality of life, and premature death. Vision problems are clearly significant public health challenges, yet they should not be barriers to healthy aging. Prevent Blindness encourages all individuals to get routine preventive eye examinations, remain physically active, eat healthy, protect their eyes from UV radiation by wearing sunglasses, and protect their eyes from injury by wearing protective eyewear when appropriate. We further encourage those living with vision problems (and their caregivers) to continue living healthy and active lives. Further information on eye health and living well with low vision can be found at www.preventblindness.org or http://lowvision.preventblindness.org/.

Michelle Boasten, RN

Electronic Visit Verification

4/13/2015 5:32:48 PM

What do older adults and their families need to manage their chronic conditions and to optimize their physical, cognitive, and behavioral health?

Older adults and their families need tools such as Physician's Health Call to become accountable for their self-care and self-management of chronic conditions such as diabetes, COPD, heart disease and depression.  Self-reporting allows the older adults and family members to take ownership of their self-care.  Physician's Health Calls are a prescription for the older adult and the family to deposit self-care assessments to the physician.  Originally used in home health, this device agnostic tool requiring nothing more than a phone and the person's own voice can be the most powerful aggregator of data to transform self-care from theory to practice.

How can we ensure that older adults know about, and take advantage of, the preventive services available to them under Medicare?

The physician simply writes a prescription for the self-care.  The older adults and family members who are accountable benefit greatly by staying healthy.  The reward of self-care and self-management of chronic disease is a better quality of life for the older adult.  Because they are healthier, there is less financial stress on the healthcare system and the need for caregiver dependency is less because they have the tools to remain independent.

How can we provide more opportunities for older adults to stay engaged and connected to their communities?

Many older adults are unpaid caregivers.  Encouraging their caregiving efforts through a reward based system offers the opportunity to keep them motivated to continue volunteering.  Non-profit organizations such as You Can Care, Inc. encourage caregiving teams that make caregiving activity measurable.  Caregiving goals can be set, reached and analyzed.

Are there current healthy aging programs or policies you think are the most or least effective or potentially duplicative?

Physician's Health Call is a healthy aging program offering an effective way for the older adult and their family members to keep them healthy by making self-care and self-management of chronic conditions accountable.

What steps can help Americans to live safely and comfortably in their homes and communities as they age?

If each physician would prescribe a Physician's Health Call it would start the expectation that self-care and self-management of chronic conditions is an expectation within the healthcare system.  By introducing the accountability of care at the self-care level it would eventually become an expectation everyone would accept as normal.  For the past 50 years, with the advent of Medicare and Medicaid, the health care professionals have assumed a greater role in the accountability of the “patient” thereby decreasing or even devaluing self-care as an option instead of an expectation.  With tools like Physician's Health Call, the accountability is put on the “patient” for self-care and self-management of chronic conditions.

What additional actions could help ensure that older adults of all backgrounds can equally enjoy a long, productive, and healthy quality of life?

Although not addressed in this policy brief, spiritual involvement and practice should be studied and included as part of the information given to older adults.  They should be encouraged to share and participate in spiritual based practices.  It would be good for all of society to learn what self-reported spiritual practices have contributed to healthy aging.  Whether through prayer beads or attending church services, many older adults report that these practices contribute greatly to healthy aging.

Donna Gavula

Independence Awareness

4/13/2015 7:27:58 PM

Enjoyed the brief and am so happy that these needs are recognized. Please keep me informed as new initiatives become available. Donna Gavula, Stepping On Master Trainer, Binghamton, NY

Linda Meneken PT

WSP Express (Wellness-Safety-Prevention)

4/22/2015 5:36:00 AM

Here here! Applause! Well stated and well said! I lecture on the topic of Self-Care, a huge supporter and Selfcare advocate! In this day and age of the ACA, it is extremely important to impress this topic into the mindsets of our healthcare providers, our patients, and the general public, from the young to the older. And Prevention is the Best Medicine, always without exception! Please keep up the good work and the good fight!

Christine Taraskiewicz

7/8/2015 7:17:57 PM

What I 'see' when reading all of these comments is that those that know about these matters have money. What about the seniors that do not and will not have funding to use these services.

There is A LOT of seniors living in poverty and so ill, sick or can't walk that they can't even ask for these services. They are too busy worrying about how they will get their next meal or deal with their illness pains because they can't afford their medications.

Ilia Stambler, PhD

International Society on Aging and Disease (ISOAD)

4/14/2015 11:40:51 AM

“What additional actions could help ensure that older adults of all backgrounds can equally enjoy a long, productive, and healthy quality of life?”

It is imperative to adopt actions and policies that promote biological research of aging and aging-related diseases to find effective means for healthy aging.

Currently, judging from the publicly available information on WHCOA, such as the recently published policy brief, this vital issue is not strongly emphasized at the WHCOA. Though the topic of Healthy Aging through life-style improvements is mentioned, and though the policy brief includes some mention of research (mainly Alzheimer's research), it by no means exhausts the need for further fundamental and applied research of basic aging processes, underlying most aging-related diseases, including Alzheimer's, but also Cancer, Type 2 Diabetes, Heart Disease, etc.

The need to support such research is expressed, for example, in the position paper of the International Society on Aging and Disease (ISOAD), entitled “The Critical Need to Promote Research of Aging and Aging-related Diseases to Improve Health and Longevity of the Elderly Population” ( www.aginganddisease.org/EN/10.14336/AD.2014.1210 ). The position paper also includes some policies that may be suggested to promote research of aging biology, such as increasing funding, providing specific incentives and institutional support for the field.

The need to support such research is also emphasized by the US Healthspan Campaign which is the primary American coalition of research institutes, scientific societies and NGOs involved in and advocating for biological aging research http://healthspancampaign.org/about-us/partners/ as well as by the NIH Geroscience Interest Group www.healthspancampaign.org/.../

Yet apparently, this approach and those organizations are not strongly represented in the WHCOA or its policy documents.

There is a great need to advance biological research of aging as this may be a single means that may ensure in the long run that “older adults of all backgrounds can equally enjoy a long, productive, and healthy quality of life”. It may be hoped that this emphasis will be made stronger and that the organizations that express it will be wider represented.

Ilia Stambler, PhD
Outreach Coordinator. International Society on Aging and Disease (ISOAD)
http://isoad.org/

Linda Meneken PT

WSP Express (Wellness-Safety-Prevention)

4/22/2015 6:10:27 AM

Dr. Stambler, thank you for your posting. Well said and well stated! We need much more prevention, research and management of long term chronic diseases.

Christine Taraskiewicz

7/8/2015 7:19:45 PM

All of the research in the world won't cure senior poverty. The 1% will see to that.

Catherine Kiener

4/15/2015 5:44:50 PM

I would like the policy brief to take the age friendly communities and the need for social interaction one step further by acknowledging the role of Multi-purpose Senior Centers in healthy aging. Senior Centers are a vital piece of the puzzle for adults as they age. They are a focal point in communities for resources, friendships, new connections, adult education, recreation, physical activity, mental stimulation, social opportunities, health promotion activities, and so much more.

Linda Meneken PT

WSP Express (Wellness-Safety-Prevention)

4/22/2015 5:41:48 AM

Donna Gavula, please contact me re: Stepping On program. I am very involved with balance assessment and exercise, and fall prevention. Thank you.

Linda Meneken PT

WSP Express (Wellness-Safety-Prevention)

4/22/2015 6:19:41 AM

To Catherine: yes, Senior Centers are very vital to the health and well-being of our older citizens. We have many active members in the SCs in our area (SF Bay Area), and I began my Fall Prevention lectures in our Concord, CA senior center in 2003! Seniors are energetic and fantastic! Especially 99 year old Louise doing Ballroom Dancing so gracefully! Thanks for your post!

Judith Kitzes , MD, MPH

University of New Mexico SOM

4/15/2015 8:24:31 PM

Please include the access to palliative care services and advanced planning. We need to support and honor the need for patient centered choice around options available with the functional decline , that might accompany healthy aging and natural death. The importance to advocate for these services as we age, enhance the quality of life for the healthy and diminish suffering. Leaving palliative care services out of the conference adds to the invisibility of the needs of the aging.

karen eyre

Individual Care Giver and Social Worker

4/15/2015 9:58:54 PM

What do older adults & their FAMILIES need to manage their chronic conditions to optimize their Physical, Cognitive, and Behavioral Health.

I found with my Mother who had a stroke and afte I saw complacency set in; ESPECIALLY  when Home Health was cut off.

  I agree with the idea of the Physicians RX for self care or the Physicians Health Call!  It would give Mom someone to be accountable to other than family members and it can be difficult telling your Parents what to do....after all they have been telling us what to do most of our lives  .It would be ideal if Home Health were allowed more freedom to decide when "time is up" for there patients and not the insurance company.

The spiritual aspect was good also, find out what they believe first then see if they want to be "hooked up".  Home Health had a pastor but he was of a different faith, Mom would roll her eyes when he showed up, I'm of a different faith than my Mom so I used him, it sure helped me out but he was suppose to be there for her.

Kuddos to llia Stambler,PHD for recognizing the need for wider representation of other Research Institutions on Aging.  Get them all together, collaborate their findings and imagine how better off we will ALL be. Thank you for this venue that allows the main population to share their experience, strength and hope.

Cathy Papia RN

4/16/2015 8:30:34 AM

As a health care professional; who care for patients in the end of life, I believe advanced care planning and education on the proven benefits of palliative care will help to ensure that all individuals receive the best health care according to their wishes. To not include these topics in the WHCOA provides a great injustice to our aging population.

e. beal

health/geri issues writer

4/16/2015 8:14:59 PM

Re: Cathy Papia's comment: My understanding is that the listening sessions going on all over the US right now (the in Cleveland is at the end of the month and has "generated" a couple of "mini-listening sessions" to get Clevelanders/NEOers ready for the session) are being done to help set the agenda/topics for the upcoming WHCoA.

So it may actually be on the agenda.

That said, one (at least this one) wonders if the decision to not include advance care planning (aka end -of-life care planning) on the topic/agenda list is to steer clear of the vitrolic discourse (remember Sara P's death panels bla-bla) including the topic would possibly/probably generate.

Xiguang Li

4/16/2015 10:41:48 AM

Seeking for a healthy aging pathway we should focus on Mental, Social and Physical order, instead of Physical, Metal and Social sequences, since mindset controls on physical health. Government polices need encourage on aging free education, which will fundamentally improve older adults’ independent and active living life. We need to build up a home based aging education system, through Television; Radio station; Computer online courses and YouTube etc. one line facilities. This educational system can keep older adults closely connected within the society; learn healthy life style; absorb broad range of knowledge; and the keeping interested busy life style can reduce all kinds of mental and physical illness.
Encourage market design specific versions’ cell phone for age 70, 80 and 90. Encourage Social Media build up specific platform for aging population. Encourage aging innovation to support government problem solving by ask question or solution in a public domain, like this conference. Let aging population confident on their capability and desire to contribute more.
Build up a National Aging Free Education System will generate benefits on every individual older adult, every family and make the whole country prosperity.

Denise Britton

4/16/2015 11:08:19 AM

Palliative Care for people with chronic life limiting diseases to help them live with their conditions. This care is holistic taking into account the whole person and family. Educational efforts to teach politicians, the public and to train more palliative care physicians and nurses should be considered in your work.

Bruce S Rabin, MD, PhD

University of Pittsburgh

4/16/2015 12:01:11 PM

We all want to remain healthy as we continue to age and then have a quick demise. Indeed, this is possible as the duration of illness before death will be decreased the longer one stays healthy. Ideally, we will stay healthy, get older, and die quickly. Unfortunately, the White House Conference on Aging Discussion Questions fail to address early life issues that influence the quality of mental and physical health as people age.

  To reduce the risk of impaired physical and mental health as one ages it is essential to understand that healthy aging begins early in life:

1.  Behaviors of the pregnant mother influence the long term mental and physical health of the child by affecting the structure and function of the developing brain. Thus, the mother’s nutrition, physical fitness, not smoking, and properly managing stress, are all essential ingredients for long term health of the child.

2.  Healthy aging is negatively affected by childhood abuse whether it is physical, emotional and/or sexual. The more abuse, the greater the risk of mental and physical health problems. This occurs because abuse of children alters the structure and function of their brain.

3.  Not being bullied and enjoying the time you spend in the workplace or personal relationships is also important to increase the likelihood of good health as we age.

Because the common biologic pathway thru which maternal stress, childhood abuse, and bullying alter mental and physical health is by elevating the concentration of stress hormones (glucocorticoids and catecholamines) in the blood; it is critical to learn how to decrease reactive stress-hormone inducing responses (fight-flight) in favor of increasing mental and physical health-inducing responses. While it is often not feasible or possible to remove the stressors from our lives there are many activities we can easily do to help keep the concentration of our stress hormones low.

A prescription for good health thru the aging process requires that:

1.  Pregnancy is a time when a healthy diet is available, time for relaxation is provided, maintenance of physical activity occurs, and levels of life stress are managed by engaging in behaviors that reduce the response of the brain to stress.

2.  The amount of abuse of children is reduced by helping adults reduce their likelihood of abusing children. To do this adults must be made aware of the effects of abuse on mental and physical health and must care about it. We must provide resources to help adults learn calming methods when they are upset by increasing abilities to cope with stress so when they are upset they do not lose control and take it out on children. Adults must help each other and when someone is upset a friend or relative or colleague needs to tell them to practice calming behaviors, for example, taking 3-5 deep breaths.

3.  An increased understanding of the harmful effects of bullying in schools, and the workplace, or in general relationships is achieved so that there will be reduction in bullying. Bullying not only affects short term health but health across the lifespan.

Many parents don’t recognize the warning signs of unhealthy levels of stress in themselves or in their children, who are particular susceptible to its negative consequences. Indeed, without greater attention to better management of stress, many of today’s stressed-out kids will go on to become chronically stressed-out, ill adults.

The behaviors that help to reduce the effect of stress on health are:
•  Having a social support system that we enjoy and can depend upon. Friends are important; being lonely may increase the risk of stress induced disease development.
•  Being optimistic that things will go well and those problems that occur will not alter our basic belief that “I am a good and well-liked person”. Always feeling that you are responsible when things go wrong can increase your chance of becoming depressed and developing heart disease and diabetes.
•  Having a sense of humor so that amusement in events and even laughter are in our daily lives (remember the old saying that “laughter is the best medicine”).
•  Being physically fit as appropriate for our age, rather than being sedentary. This does not mean we have to go to a gym and work out. We simply need to increase the amount of our daily walking.
•  Participating in religious activities or having a spiritual nature that allows enjoyment, relaxation and calming behaviors when faced with stress

Unfortunately we do not spend enough time planning for the quality of our health as we age. As this planning must begin early, before young children are aware of factors that may affect their health several decades into their life, it is the responsibility of the adults who love them to begin practicing healthy lifestyle behaviors with them.

Linda Meneken PT

WSP Express (Wellness-Safety-Prevention)

4/22/2015 5:58:17 AM

Dr. Rabin, very well stated! Thank you for your posting. I have always said, in my long career as a wife, mother, sister, and physical therapist, that one should examine a person's childhood and upbringing carefully to predict their possible results/outcomes re: successful adult living! It (one's childhood experiences) is almost always the most telltale factor in predicting how an individual adult's life course will develop and end. And then, of course, there is the genetics factor also!

Micki Nozaki

California Senior Medicare Patrol

4/16/2015 12:15:19 PM

One important aspect of Healthy Aging depends on having adequate financial and health care resources. Living safely is an assurance that our seniors are not being victimized by fraudsters and criminals. Too many of our seniors are vulnerable to scams via the phone and email and unwittingly divulge personal financial and health care information. This information is then used by the criminal to steal from bank accounts or submit fraudulent Medicare claims in the senior's name, threatening access to their health care benefits.

Prevention is the key. We need to educate seniors, their families, caregivers and the general consumer population about financial and medical identity theft and empower them to avoid falling prey to fraudsters.

Suzette Boydston

Samaritan Senior Companion Program

4/17/2015 4:51:45 PM

Expanding on Senior Corps, The Foster Grandparent Program, which support older adults in mentoring children, as well as the RSVP tackling tough issues in their communities and the Senior Companion Program, the cost effective answer to long-term care.

Established in 1973, the Senior Companion program (SCP) is a cost-effective answer to long-term care.  SCP volunteers serve thousands of older and frail adults by providing companionship to offset isolation, provide transportation to medical appointments or help with essential errands to facilitate seniors remaining in their own homes.  Through the Senior Companion program, these services are provided at a cost much lower than those incurred by placement in an institutional care setting.  For many older Americans, receiving services from the Senior Companion program is a cost-effective alternative to long-term institutional care.  As the cost of long-term institutional care continues to rise, the cost of Medicare and State Medicaid increase as well.  The average cost of long-term care can range from $48,000 to $72,000 per year, while the annual cost of one Senior Companion volunteer is less than $5,000 for an average of 1,044 hours of service.

The traditional clients of the Senior Companion program are frail seniors and particularly women over the age of 85, who live alone.  Other clients include individuals with disabilities, home-bound veterans and cancer patients who need SCP assistance to undergo lifesaving medical treatments.  Volunteers also may provide valuable respite care to informal caregivers or family members caring for a loved one at home.  Caregiving can have a negative impact on the caregiving family’s economic opportunities, and caregiver burnout is an important contributor to premature nursing home use.  Senior Companions offer a valuable form of regular support that allows the caregiver to maintain their role as caregiver and keeps families intact.  Senior Companion volunteers derive significant emotional and health benefits from their service.  It's a win-win.

SCP volunteers are 55 or older and low-income.  Prior to enrolling in the program, potential volunteers must undergo comprehensive application, orientation and training processes.  Before they begin to serve 15 to 40 hours a week, they must also complete and pass extensive national background checks.  Volunteers who are at or below 200 percent of the federal poverty level are eligible to receive a modest stipend of $2.65 per hour to help offset the cost of volunteering.  Many Senior Companion volunteers use this stipend to keep their vehicles in good operating order, purchase gas and auto insurance; cover heating and medical bills or to help pay for prescriptions.  Volunteers also receive service-related insurance, mileage reimbursement, and other non-monetary incentives.

In 2011, states and local communities contributed $22.9 million in non-federal funds to support the Senior Companion program.  This amount is well above the ten percent non-federal share required by the program sponsors, and demonstrates the value of the essential services that Senior Companion volunteers provide in their communities.

Service is Ageless!”

Martin Ekoumou, MD, MPH

Don't Lose Hope DLH

4/20/2015 5:22:35 AM

Getting old is neither a curse, nor is a disease; instead it is a privilege; a true blessing. This is what I tell the geriatric population as I promote wellness and the quality of life for all elderly.

Unquestionable, the White House Healthy Aging Policy is a truly breakthrough good news; but not only that; it is a way long due strategy to help the American elderly to individually add good health, wellness, and happiness to their years.

Pat Dougherty

University of Washington Encore Initiative, Social Venture Partners, JV EnCorps, Encore.org

4/22/2015 4:06:23 PM

I write on behalf of myself and Jim McGinley, Helen Pitts, Nancy Peterson, Laura Saunders. We attended the recent White House Conference on Aging Regional Forum in Seattle, April 2, 2015, designed as a listening session in preparation for the national White House Conference on Aging later this year. At this workshop we participated in the Healthy Aging breakout session, which proposed the following as one of two priorities:

“Support a paradigm shift from a deficit to an asset model of aging in America with a strong national statement and leadership on positive aspects of aging in the face of demographic shifts.”

We appreciate the April 10th WHCOA Healthy Aging Policy Brief acknowledging the resource and strengths of the older adult population, and not only the deficits that can accompany aging. However, we believe that the national White House Conference on Aging presents a unique and noteworthy opportunity to further stress the incredible opportunities presented by the retiring baby boomer generation and their successors to transform society for the better. Their potential to have a positive social impact on real societal needs should not be underestimated.

A national statement about the importance of this population for critically needed social service will inspire our country as well as this increasing population, which is emerging from primary careers eager to make a difference for the greater good. President Obama and Michelle Obama making such a statement together can inaugurate a fresh and compelling approach to aging, one that values the role of the elder for our future greater good.

Through our careers and professional connections with Encore.org, Jesuit Volunteer EnCorps, Social Venture Partners and the University of Washington Encore Initiative we participate in an emerging social movement to create an ‘encore’ life-stage for this age cohort. Daily we see strong interest among boomers and adjacent age groups who want to stay engaged with younger generations and make a difference. Giving back contributes to healthy aging. In turn, service agencies and non-profits of all kinds need to be encouraged to develop structures to take advantage of this opportunity. Help us make it so.

Sherry Dougherty

4/24/2015 3:57:12 PM

I am no longer interested in living as long as possible, i.e., have my life saved at all costs (physical, emotional, spiritual and financial).

I wish to live WELL, right up to the end. This includes conversations with my family members and doctors about what I want to do before I die, and what I need to say to those I love.

Dr. Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston, and excellent physician writer, is the author of BEING MORTAL: Medicine and What Matters in the End. He asserts that by saving lives when good quality of life is no longer possible, doctors are not honoring their hippocratic oath--they are causing devastating harm.

Good palliative care and a patient's wish for a peaceful death needs to be discussed openly between physicians, patients, family members, and all media.

Thank you,
Sherry Dougherty

Ida Greenlee Cheeks

4/24/2015 8:04:28 PM

Thank you for "Promoting Community and Civic Engagement" for the 2015 White House Conference On Aging...This is a vital factor for our Multigenerational Diversification of Communities. We are a diverse racial entity. Plus, we Seniors are still a viable and sustainable entity in planning for ALL programs. We have a Web of knowledge and wisdom base that is substantial and sustainable. We have been ignored far too long. The young people still need to be educated of our past, present and future endeavors. Please do not forget to tap into our Reservoir of being a living, breathing and contributing book of Sustainable Education...I concur with Annie G. of Illinois, "A focus on health, education and humanities will help provide opportunities for us to be, live, and contribute our best self..." Let us forge ahead and divert some of this River of Living and Flowing Water of Wisdom...Seniors assisting in "Promoting Community and Civic Engagement."

Amber Robinson

The Vision Council

4/29/2015 11:21:45 AM

“What do older adults and their families need to manage their chronic conditions and to optimize their physical, cognitive, and behavioral health?”

In the case of low vision, older adults and their families need counseling and education and the afflicted older adults need access to quality low vision care, including the appropriate low vision devices to help them accomplish their visual goals.

“How can we ensure that older adults know about, and take advantage of, the preventive services available to them under Medicare?”

In the case of low vision, specific procedural codes dedicated to the provision of low vision care would very helpful.  Those that suffer with low vision rely heavily on their Optometrists and Ophthalmologists for guidance and care.  A dedicated Medicare procedural code for low vision care with encourage more eye doctors to offer this service or at least be able to refer for it with specific knowledge of insurance coverage.  In addition, low vision care should be made part of the ‘standard of care’ for eye conditions that result in impaired vision due to central field loss, peripheral field loss or diseases of the media.

“How can we provide more opportunities for older adults to stay engaged and connected to their communities?”
Low vision care is a service that keeps older adults living independently and safely.  A safe, independent senior stays involved in communities and social networks.

“What steps can help Americans to live safely and comfortably in their homes and communities as they age?”

As mentioned above, low vision care helps seniors with vision loss live safely and independently, whereas seniors with vision loss but not receiving low vision care lose independence sooner and bear a greater risk of falls and accidents around the home.  Low Vision Care helps visually impaired seniors ambulate safely around the home environment, administer medications safely and accurately, maintain key dietary restrictions and guidelines, and not to be overlooked, enjoy their avocations by restoring an ability to read, watch television, play cards or engage in any number of activities.

“What additional actions could help ensure that older adults of all backgrounds can equally enjoy a long, productive, and healthy quality of life?”

Older Americans that are diagnosed with vision loss, however severe, should be offered low vision counseling or care or referred for same.  The earlier a visually impaired individual becomes aware of the benefits of low vision care the more they will benefit as their vision declines.  Raising awareness through public education, increasing clinical care of the visually impaired through slight changes to Medicare and making low vision care part of the standard protocol for treating underlying eye diseases will help to ensure that those with vision loss enjoy their quality of life.

Cheryl Bartholomew

Seniors 'N Sync, LLC

5/2/2015 5:45:04 PM

Let our voices be heard….
As a certified senior fitness instructor and founder of Seniors ‘N Sync, LLC, I have been involved in many aspects of older adult wellness and fitness since 2000.  In 2005 I attended the WHCoA as an at large delegate from VA with high expectations of making a difference for aging Baby Boomers.  Those hopes were quickly squelched due to the disorganization and politicizing of the conference agenda. It was a huge debacle and at large delegates had little opportunity to present their ideas because government agencies monopolized the discussions in an effort to accomplish their own agendas.  Therefore I appreciate the opportunity to express my concerns and to appeal to the organizers of the 2015 White House Conference on Aging to focus on the needs of the Baby Boomer generation and to recognize that they view aging in a completely different light than their predecessors.
As an active member of the International Council on Aging for thirteen years, I strongly support the need to “change the way we age”.
•  First and foremost our nation needs to do more to foster “preventative” approaches to healthcare and provide incentives for older adults to take responsibility for their health.  We must change the paradigm of older adult healthcare from an “illness” model to a “wellness” model.  The medical community needs to embrace alternative methods of care and insurances need to cover alternative methods of treatment.  Physicians should be better versed in a holistic approach to care that encompasses the seven dimensions of wellness rather than resorting to pharmaceutical solutions.  Insurance companies should provide incentives/ discounts for all persons over the age of 55 who seek and participate in fitness programs within their community.  If fitness programs are taught by certified fitness instructors who specialize in older adult fitness, they should be recognized as a valuable resource and their programs should be funded or granted full or partial payment for the enrollee by his/ her  medical insurance company.  The current trend of offering reimbursement or membership fees for only those companies that have proven clinical results in reimbursement for the more functional seniors and discriminates against those who need functional fitness exercise due to disabilities, chronic health conditions, continued exercise once released from medical rehab etc. Offering memberships to nationally established companies that “clone” their programs in gyms means is counter-productive because most deconditioned seniors refuse to set foot in gyms as they are typically not age friendly.  The health club staff is often not senior certified and do not have the patience or know how to work with older adults. A gym is often a constant reminder of declining abilities and health because it exudes athleticism and caters to the younger generations. It is time to embrace the local businesses that reach out to and cater to the individual needs of their clients.  Small businesses don’t mass produce videos; they take a personal approach and responsibility for each person they serve.
•  The local venue for senior fitness is often routed in “senior centers” or community centers that date back to their 1970’s roots in terms of management style, program offerings, unwholesome meals, social activities etc.  They are outdated and receive inadequate funding on a national and/or state level. Baby Boomers refuse to associate themselves with the current model of senior center because of the stagnant, repetitive and often passive options appealed to the “golden years” generation, but lack purpose and opportunities for the current aging population. The term” Senior Center” conjures up thoughts of Bingo, unhealthy food, card games, and passive entertainment that encourages to much sitting, little or no cognitive stimulation and little variation in  routine; all of which are detrimental to our physical and mental wellbeing!  Innovative methods of funding senior and community centers need to be implemented to create life enrichment centers that offer older adults an opportunity to remain productive and contributing members of society.  They should be age friendly and encourage intergenerational interaction.  There should be educational opportunities for older adults to keep their minds sharp and learn how to navigate in our fast paced, technology world. These new models should provide brain fitness and computer courses as well as popular arts and craft classes and promote meaningful volunteer projects that will encourage older adults to remain engaged in their community and in life!  The older adult population should play a role in operating the center and should have input as to what is offered on their behalf. However, the new centers must embrace all generations and tap into the resources and benefits of intergenerational interaction.  Older adults can provide baby-sitting,  tutoring or mentoring assistance; while teenagers can offer to instruct older adults how to use a mobile phone, navigate the internet or become familiar with a computer.  The new life enrichment models are created to  bring communities together. They demonstrate respect for the contributions of the older adult population, past and present. They promote purposeful living for all older adults regardless of physical or cognitive challenges.  The new community centers should create spaces that encourage socialization by implementing “coffee café’s” and bistros that offer healthy foods prepared by and/ or distributed to the center by local restaurants that compete/bid for the opportunity to cater to the center.  Partnerships with local businesses are a must!   We must find creative ways for businesses to contribute to and support the local community life enrichment center. Let’s make community service through business count!  Maybe they could qualify for a tax break if they provide a service or food that benefits the center.  It is time to think outside the box!
•  Community life enrichment centers can also act as a catalyst for support systems necessary to promote aging in place!  Most Baby Boomers are not considering retirement until absolutely necessary, for various reasons; the desire to keep working, the stimulation and purposeful living that the job market offers, the lack of retirement funds etc.  Many older adults can’t afford Long Term Care insurance to provide for their extended life needs.  Most older adults  choose not to live in a senior living community or they simply can’t afford the cost to do so.  Therefore our local state governments need to take action immediately to establish aging in place alternatives that will allow older adults more than meals on wheels and transportation to doctor appointments!  There are several successful “aging in place” models ranging from the “village” approach to other more innovative designs including but not limited to the Communitarian alternative to aging in place. Aging in place should allow for safe transportation to and from social events, fitness classes, educational seminars or the local University, visiting friends, entertainment options etc.  Without the systems that support engagement in life and purposeful living, seniors simply become relegated to being home bound.  Being home bound leads to physical, social, emotional, mental, and intellectual decline.  It feeds into the illness model of care; not the wellness/ preventative model of care. What will it take to help older adults remain cognascent, active, and independently functional for as long as possible?  Fitness is the foundation for wellness. When a person lacks confidence in his/her ability to function and perform necessary tasks in a safe and capable manner, he or she won’t reach outside their safe environment to interact with others, volunteer or mentor, become involved or committed to causes or expand their horizons.  Quality, safe and appropriate exercise that promotes functional fitness is the key to successful aging and unlocks the door to all dimensions of wellness.
•  Finally, while I believe we need to safeguard Medicare, the Older American Act and Social Security, we need to be open to change that will better serve the Baby Boomer population over the next decade.  Medicare dictates and restricts the types of services and the conditions under which they may be offered through Home Health Care Agencies. These rules and regulations mandate that a person become dysfunctional in order to receive care through the system. This is wrong; we need to change the policies and allow Medicare to embrace and partner with wellness and fitness professionals who can provide a proactive approach to assist homebound clients to improve their health.  Again, Medicare is mired in the “illness” care syndrome rather than the preventive approach to care.
•  Instead of just talking about the importance of prevention through exercise, diet, stress management and how to keep our cognitive faculties from deteriorating, we need to provide ways to attain optimal health through our national government, state and locally sponsored programs, grants and funding options. The taxpayers can’t carry the burden for all of what is needed.  It is time to appeal to and tap into businesses with the expectation and requirements that they find a way to partner with and contribute to the health of the communities that support them.
The time for “talk” has passed; it is now time for action!  Listen to the organizations that serve and understand the needs of older adults ( AARP and the International Council on Active Aging to name a few). Those responsible for organizing and  implementing the 2015 WHCoA need to get it right this time.  It was very frustrating to not receive valuable White Papers that deserved serious consideration before it was time to vote or propose policies at the 2005 conference.  I was so disillusioned and disgusted with the lack of organization and the political protocol that dictated the narrow-mindedness of the agendas in 2005 that I wrote an article which was published in the Journal on Active Aging (ICAA) entitled: “A Missed Opportunity for Active Aging”. In it I expressed my feelings of despair regarding likelihood that the Baby Boomer generations projected needs would be ignored or put aside until 2015 at the earliest.  Why do we procrastinate?  Why can’t we be proactive?  Much of what we needed yesterday has been put off until we are in a state of crisis…..inexcusable!   It is time to demonstrate respect and acknowledgement for all that the Baby Boomer Generation created and improved throughout their lifetimes.  It is time to give back and grant the services they require in the manner in which they will embrace them.  Allow them to age with dignity. This is last opportunity we will have to do that!

Claire

5/24/2015 8:10:19 PM

I have been a member of Senior Sneakers for about 10 years and was on Social Security Disability when I joined.  This program saved me.  Maybe not my life, but ME.  It wasn't long until I decided to give Zumba Gold a try.  Loved it.

At age 68 I was on my own, needing a job and bored to tears.  So, I decided to go to school.  Technology had run off and left me, I allowed my certification to lapse because I didn't think I would be able to work again.  May 9, 2015 I graduated from a Health Information Management program at our local community college with a 4.0 GPA, sat for the certification exam and am now a Certified Coding Specialist and have a position at our local medical center as an inpatient coder.  I have a home of my own, the absolute perfect job, my health; of course I still take pills in the morning but not nearly as many as before, and my beautiful family, including a 5 y/o great grandson.  I will be 70 years old on June 5.

Social Security, Pell Grants, Student loans, Medicare all helped me.  But I had the will to go ask for them.  I also had the means and the know how to use a computer and search for what I wanted.  There must be thousands like me who would do what I did if they knew it was available and had someone to push them a little.

First step was the SilverSneakers program at the senior center.  You guys who are involved in the administrative and legislative portion figure out how to do it, build it and we will come so to speak, and more seniors who are alone will be taking care of themselves and enjoying it.  I surely am.

Lindsay Goldman

New York Academy of Medicine

5/6/2015 5:27:21 PM

The New York Academy of Medicine (The Academy) applauds the White House Conference on Aging’s Healthy Aging policy paper for recognizing that “age-friendly, livable communities help support independence for older adults.” The Academy founded and staffs Age-friendly NYC (www.agefriendlynyc.org), an unprecedented public-private partnership between The Academy, the Office of the Mayor, and the New York City Council that strives to make New York City a better place for older people to live and work.

Beginning in 2007 using the World Health Organization’s framework for age-friendly cities, The Academy has spoken to thousands of older people in New York, as well as other localities, such as Washington, DC, to help identify and remove barriers to maximum physical, social, and economic participation. Some of our most notable successes in New York City include a 21% reduction in senior pedestrian fatalities through mitigation measures implemented around major intersections; 4,000 new bus shelters and 1,300 additional benches to enable people to sit comfortably while in transit; and the introduction of senior swim hours with water aerobics at 16 public pools to increase physical activity. Former Mayor Bloomberg began this effort by convening 13 City agencies, and as a result, the City has seen lasting improvements to the built environment, more strategic use of resources, and enhanced recreational, educational, and cultural programming throughout the five boroughs.

The Obama Administration can similarly advance the spread of age-friendly communities by modeling age-friendly planning at the federal level. Section 203 (c) of the Older Americans Act authorizes a Federal Interagency Coordinating Committee on Aging to convene Federal agencies to work together to optimize the wellbeing of older people through existing programs and services. Without funding attached, the Committee has not moved forward. The White House Conference on Aging provides an excellent opportunity for the President to issue an Executive Order tasking agencies with developing action plans to harness the assets and meet the needs of a growing population of older Americans. Internationally acclaimed in aging and public health, The Academy would be pleased to serve as a resource should the Administration choose to explore this approach.

Ashton Applewhite

thischairrocks.com

5/8/2015 3:34:03 PM

A growing body of evidence shows that attitudes towards aging have an actual, measurable, physical effect on how we age. The way we internalize cues in the environment—as abstract as the way older people are depicted in the media or as concrete as that emerging bald spot—significantly affects our physical and psychological trajectories. In an ageist culture like this one, almost all those cues are negative. Over and over, Yale University’s Becca Levy has found that people with more positive feelings about aging behave differently as they age from those convinced that growing old means becoming useless or helpless. Those with more positive views do better on memory tests. They can walk faster. They’re more likely to recover fully from severe disability. They actually live longer—an average of seven and a half years.

How about a national anti-ageism campaign to raise awareness of age-based stereotypes and the damage they do? The benefits to health and human potential would be immense.

Cheryl Bartholomew

Seniors 'N Sync, LLC

6/14/2015 11:14:28 AM

I second this suggestion!

Donald Shulman

Assocation of Jewish Aging Services

6/30/2015 12:42:52 PM

I'm with you too Cheryl....

Andrea Gilats, Ph.D., R.Y.T. (Registered Yoga Teacher)

5/9/2015 11:11:37 AM

My three decades of work in lifelong learning focused on developing programs rather than policies, but since policies drive programs, I would like to comment on both.

I’ve become convinced that physical mobility—the ability to move freely so that we can preserve our freedom of choice, live independently, and direct our own lives—is prerequisite to all the forms of engagement discussed in the Healthy Aging Policy Brief and to cognitive health and injury prevention. There is now plenty of research (enough to convince me, at least) showing that physical inactivity, not simply the passage of time, is an overriding factor in loss of mobility. If we are looking ahead at the “costs” of an aging population, we should be deeply concerned this.

Our policy goal should be to help older adults—those living through their encore eras—preserve their physical mobility through regular, frequent, planned exercise. We know this already. To me, part of the challenge lies in forming effective partnerships, whether with the medical community, especially prescribing doctors; other health and fitness professionals, including physical therapists, trainers, fitness instructors, and yoga teachers; and the social services and lifelong learning communities, especially community centers, senior centers, and community-based adult education providers.

I’m an unabashed proponent of gentle, body-sensitive approaches to yoga for older adults because yoga is holistic. It unites the body, the breath, and the mind to enhance flexibility, strength, agility, and balance. (Yoga is an effective form of fall-prevention training.) Yoga also contributes to healthier posture, elevated well-being, cognitive health, and stress relief.

Whether yoga or another form of exercise, we must train fitness instructors and yoga teachers to work safely and effectively with older bodies so that we can provide exercise programs that older adults will want to stay with over time and incorporate into their everyday lives.

Joan Ilardo, PhD, LMSW

Michigan Aging Education Collaborative/Geriatric Education Center of Michigan

5/20/2015 4:39:12 PM

Thank you for the excellent policy brief on Healthy Aging. As we face quality of life issues, the best solution is to maintain as much physical, cognitive, social, and financial well being as possible. Promoting physical activity, good nutrition, prevention and self-management are keys to optimizing quality of life. The piece that is missing in the brief is that healthy aging doesn't start at age 60; it is a mind set and skill set that starts in childhood and carries on into adulthood. Intergenerational programs that promote these principles would encourage community and civic engagement as well as physical health.

In regard to maximizing independence in homes and communities, here again there are tremendous opportunities for intergenerational activities through service and faith-based organizations as well as youth volunteer programs such as National Honor Society, 4H, and faith-based organizations. Support and technical assistance for innovative residential models such as co-housing could also assist older adults remain part of an active community living experience.

Alison Berglund

5/28/2015 10:36:31 AM

One of the most important opportunities for healthy aging is having a sense of purpose. In every local community there is an opportunity to look at community or societal issues and tap into the skills & talent of the 50+. Building an infrastructure to organize this benefits both the community for future generations, as well as the individual who shares their talents. If one has a sense of purpose and significance many of the health & aging challenges can be overcome.

Howard Bedlin

National Council on Aging (NCOA)

5/28/2015 4:01:12 PM

NCOA Healthy Aging Recommendations
2015 White House Conference on Aging

Chronic diseases are the leading causes of death and disability in the U.S. and account for 75% of the nation’s health care spending. Older adults are disproportionately affected; 80% have at least one chronic health condition, and more than half have multiple chronic conditions, which are especially difficult and costly to manage. With an aging population and unprecedented obesity rates (a risk factor for many chronic conditions), the burden of chronic disease is rapidly increasing and causing extraordinary challenges for the U.S. health care system.

Older adults with chronic conditions face a number of barriers in terms of coping with their illness and optimizing their health, which include lack of social support, low skill levels for symptom management, and low confidence in their abilities to manage their conditions (self-efficacy). Self-management is heralded as a key component in the improvement of health outcomes associated with chronic disease. According to the Institute of Medicine, self-management is defined as “the tasks that individuals must undertake to live well with one or more chronic conditions.”

Scientific studies have shown that participation in chronic disease self-management education (CDSME) programs can improve health and functional outcomes and save health care dollars by reducing hospitalizations and emergency room visits. The Stanford Chronic Disease Self-Management Program (CDSMP), one of the most well-known and researched evidence-based programs, is a good model for people with multiple chronic conditions (MCCs), as research studies have demonstrated positive changes in self-efficacy, health behaviors, physical and psychological health status, and symptom management.

In addition, one in three Americans aged 65 and over falls each year. In 2013, 2.5 million nonfatal fall injuries among older adults were treated in emergency rooms with more than 734,000 of these hospitalized. Among older adults, falls are the leading cause of injury death. In 2012, $30 billion in direct medical costs was spent treating older adults for the effects of falls, with 78% of these costs reimbursed by Medicare. If we cannot stem the rate of increase in falls, it is projected that the cost in 2020 will be $67.7 billion, including Medicare costs estimated at about $48 billion.

Many of our recommendations are closely aligned with and responsive to the DHHS strategic framework to improve the health status of individuals with multiple chronic conditions.  In particular, we focus a great deal on Goal 2 (“Maximize the use of proven self-care management and other services by individuals with multiple chronic conditions”) and Objective A on facilitating self-care management.  Specific strategies from the framework in this area include:
•  Strategy 2.A.1. Continually improve and bring to scale evidence-based, self-care management activities and programs, and develop systems to promote models that address common risk factors and challenges that are associated with many chronic conditions.
•  Strategy 2.A.2. Enhance sustainability of evidence-based, self-management activities and programs.
•  Strategy 2.A.3. Improve the efficiency, quality, and cost-effectiveness of evidence-based, self-care management activities and programs.

The following are ten recommendations to promote healthy aging from the National Council on Aging (NCOA):

1.  Enhance Access to CDSME and Family Caregiver Support Programs for Veterans and Federal Employees

Building Better Caregivers is an online workshop aimed to equip caregivers with knowledge, skills, and peer support to boost confidence, reduce feelings of burden and stress, and improve overall mental and physical health. The program is currently available to family caregivers through the Department of Veterans Affairs. Since 2012, over 1,400 caregivers have participated in workshops. However, recruitment efforts to date have primarily focused on caregivers of younger, post-9/11 veterans with traumatic brain injury and post-traumatic stress disorder. In partnership with the aging services network, additional outreach and recruitment should be undertaken to reach family caregivers of older veterans with disabilities who could also benefit from this program.

As the country ages, increasing numbers of workers are juggling work and family caregiving responsibilities. Businesses lose up to $33.6 billion annually in work productivity and absenteeism due to caregiving responsibilities of full-time employees. In addition, businesses face approximately 8% higher health care costs of employees with eldercare responsibilities, potentially costing an estimated $13.4 billion per year.

The Department of Health and Human Services (DHHS) should play a leadership role in making evidence-based family caregiver support programs, such as Building Better Caregivers, available to federal workers.

The average age of the federal workforce is also increasing. Many workers are living with multiple chronic conditions which are costly in terms of absenteeism, loss of productivity, and health care claims. Furthermore, chronic diseases have a negative effect on quality of life for the employee and can lead to disability and premature death if not appropriately managed. The DHHS has invested in evidence-based programs and supports national dissemination of proven healthy aging programs, such as the suite of CDSME online and community-based programs.

The federal government should be a model employer by promoting the availability evidence-based health programs to federal workers. As such, NCOA recommends that the Administration issue an Executive Order to form a task force to enhance access to CDSME and family caregiver support programs for federal employees. Access for federal contractors should also be considered. The task force should be led by the Office of Personnel Management and consist of representatives from the Administration for Community Living, Centers for Disease Control and Prevention (CDC), National Institute on Aging, Office of Women’s Health, Federal Occupational Health, other federal agencies, and health plans serving federal employees. In addition, NCOA recommends that the Department of Veterans Affairs partner with the Administration for Community Living to enhance access to online evidence-based family caregiver support programs for caregivers of aging veterans.

2.  Expand the Patient-Centered Medical Home (PCMH) self-management quality standards to other delivery models for Medicare

With respect to self-management, diabetes self-management training (DMST) and chronic disease self-management education programs have demonstrated success in improving health outcomes, promoting more appropriate health care utilization, and reducing health care costs for people with chronic conditions. The American Medical Association Physician Consortium for Performance Improvement-National Committee for Quality Assurance (NCQA) recommendations contain outcome and process measures to improve health status. Specifically, they include initiation of a DSMT program within 12 months of new diagnosis, and initiation of a DSMT program within six months before or six months after the start of insulin therapy. In addition, aspects of self-management are included in patient experience metrics on discharge (National Quality Metrics Clearinghouse [NQMC]: 005475), for behavioral health services (NQMC: 000850), and for disease-specific treatment plans.

In addition, the NCQA measures associated with patient-centered medical home (PCMH) certification include criteria for evaluating self-management skill-building within medical practice. Consideration should be given to taking current PCMH self-management quality metrics and applying many of them to the Physician Quality Reporting System (PQRS), Accountable Care Organizations (ACOs), Chronic Special Need Plans (SNPs), and Medicare Advantage Star Ratings. Specifically, NCQA’s PCMH Standard on Care Management and Support (Standard Four) measures include 4B: Care Planning and Self-Care Support and 4E: Support Self-Care and Shared Decision-Making. These measures capture critical elements of care that support self-management for people coping with chronic illness.
(www.ncqa.org/.../PCMH2014Standards.aspx).

NCOA recommends that we begin the process of including these Chronic Disease Self-Management quality metrics in standards for other Medicare providers, such as Medicare Advantage plans and ACOs.

3.  Strengthen the Annual Medicare Wellness Visit to Better Promote Healthy Aging

Section 4103 of the Affordable Care Act provided Medicare coverage for annual wellness visits, which include a personalized prevention plan. NCOA recommends that this provision be strengthened to better address the needs of older adults with multiple chronic conditions, specifically:
•  Improve requirements for screenings and referrals to CDSME and falls prevention interventions, including specific protocols, recommended best processes and practices, and use of CDC’s STEADI tool;
•  Provide billing codes for falls risk assessments and for patient activation assessments;
•  Develop standards for post-visit follow-up to better ensure compliance with the personalized prevention plan and referrals;
•  Broaden the permissible circumstances under which visits can be conducted in a beneficiary’s home.

Electronic health records vendors are incorporating assessment tools into their software. For example, Epic, an electronic health records software system for medical groups, hospitals, and integrated health care systems, will release a an update of their tool that will include CDC’s STEADI algorithm for falls risk assessment. This electronic tool will provide a more streamlined approach for health care providers to integrate falls risk assessment into patient care and will include the capability to refer patients to local evidence-based falls prevention programs.

4.  Provide assistance to states on how to incorporate evidence-based healthy aging programs within their Medicaid programs

Several states have successfully incorporated evidence-based healthy aging programs within Medicaid. Some states have included CDSME in 1915(c) Home and Community-Based Services (HCBS) waiver programs. Others have sought to include evidence-based healthy aging programs within Medicaid managed care and duals integration demonstrations. States have a great deal of flexibility to incorporate evidence-based programs and related supports for participation (e.g. transportation) through various Medicaid HCBS authorities and programs, such as the 1915(c) HCBS waiver programs, 1915(i) State Plan Option, Health Homes, and Money Follows the Person Demonstrations.

Some of these options could provide an enhanced federal match. For example, the Medicaid Health Home benefit allows states to receive an enhanced federal match to implement Health Homes to support an integrative, whole-person approach to care for individuals with two or more chronic conditions, those with one who are at risk for a second, and those with a serious and persistent mental health condition. Services can include care management and coordination, health promotion, transitional care follow-up, and referrals to community and social support services. States could better utilize this option to provide evidence-based healthy aging programs. NCOA recommends that CMS provide technical assistance to states on incorporating evidence-based healthy aging programs within Medicaid. The Medicaid Innovation Accelerator Program  could provide a platform to deliver technical assistance on these issues to states.

5.  Conduct a new CMMI demonstration on Integrated Self-Care Planning (ISP)

Self-management education and support in health systems and the community are highly fragmented, and neither sector has a practical process for integrating services at the patient/consumer level. To fill this gap, the Center for Medicare and Medicaid Innovation (CMMI) should be directed to develop and test Integrated Self-Care Planning (ISP), in which primary care and community service providers collaborate and integrate support to help older adults and their caregivers reach personal goals for aging well. This new process would bring together older adults, caregivers, primary care providers, and aging network providers so they have a shared pathway to managing each person’s chronic conditions. Practical protocols for team-based care planning would be developed that center on older adults’ goals and results in individualized service integration.

Using the ISP process, a primary care provider and trained community coordinator from an aging network provider would help older adults and caregivers set and track personal goals and outcomes. This care team would draw on health system and community resources to guide the coordinated delivery of self-care education, programs and services from both sources. Periodic team meetings, supplemented with technology-based communications, would assess progress and then update the goals, plan and service mix. The ISP model would directly respond to the call from health systems, payers, and consumer advocates for integrating clinical and community-based support for self-care.

6.  Add Second Falls as a Hospital Readmissions Reduction Program Measure

The Hospital Readmissions Reduction Program, mandated by the ACA, requires CMS to reduce Medicare payments to inpatient prospective payment system hospitals with excess readmissions. This program went into effect on October 1, 2012. This is a penalty program that reduces the base diagnosis related group (DRG) payments for discharges as result of performance on specific readmission measures. Such measures currently include unplanned 30-day readmissions for acute myocardial infarction, heart failure, pneumonia, chronic obstructive pulmonary disease, elective total hip arthroplasty and total knee arthroplasty. In 2017, CMS will add a measure for 30-day unplanned readmissions for coronary artery bypass graft surgery. NCOA recommends that a measure be added in 2017 for readmissions due to a second fall and could include fractures, brain injuries, and other injuries resulting from a fall.

7.  Fund a Medicare Demonstration Modeled after the Medicaid Incentives for Prevention of Chronic Diseases Program

Section 4108 of the ACA created the Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) program for States to develop and implement evidence-based chronic disease prevention approaches to demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors. The initiatives must be comprehensive, evidence-based, widely available, and easily accessible. Ten states were awarded grants test the use of incentives addressing at least one of the following prevention goals: tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or when there is a diagnosis or diabetes, improving the management of the condition.

NCOA recommends that a similar Medicare demonstration program be designed and funded targeting high risk beneficiaries, including dual-eligibles. Properly constructed based on recent learnings, evidence-based interventions and incentives to promote healthy aging and behavior change for this population has great potential to reduce Medicare spending and improve lives.

A relevant legislative proposal worth examining is the Medicare Better Health Rewards Program Act of 2013 (S. 1228), introduced by Senators Wyden and Isakson. The demonstration would establish a point system to enable participant beneficiaries to receive up to $400 per year if they comply with the protocols developed by the Cleveland Clinic, including those for: (1) an annual wellness visit, (2) tobacco cessation, (3) Body Mass Index (BMI), (4) a diabetes screening test, (5) cardiovascular disease screening, (6) cholesterol level screening, and (7) screening tests and specified vaccinations.

8.  Include CDSME in new Medicare billing codes for complex chronic care

NCOA recommends that Medicare billing codes for Chronic Care Management (CCM) services include the provision of CDSME. Considering that the vast majority of chronic condition management takes place outside of the health care setting, providers should be able to bill for those patients who attend a CDSME workshop either in-person or online. These workshops are available throughout the country, with more than 256,000 participants to date.

9.  Provide funding to develop sustainable models for integrating community-based organizations that offer CDSME with health care providers to improve health care outcomes and save health care dollars

The Administration for Community Living/Administration on Aging and the CDC have provided funding to support state and community-based organizations in expanding CDSME and infrastructure to support them. With the passage of the Affordable Care Act, opportunities for integrating CDSME programs with health care systems exist that have never before been available. State-level and community-based organizations are making great strides with sustaining programs by embedding them in health care systems.

The uncertainty of future funding provides challenges to continuing the forward momentum.  NCOA recommends that additional funding be provided to identify, describe, and support sustainable models that can be replicated to ultimately provide uniform and nationwide access to these low-cost, effective programs. Funding is critical to continue the gains that have been made toward improving the quality of life for millions of older adults and lessening the burden of an aging population on our nation’s scarce health care resources.

10.  Increase Prevention and Public Health Fund (PPHF) allocations for evidence-based CDSME and falls prevention programs

Major published studies have found that CDSME results in significant, measurable improvements in the health of people with chronic conditions, as well as cost savings:
•  A 2013 national study supported by the Administration on Aging of 1,170 CDSMP enrollees found $364 net per person savings in reduced emergency room visits and hospital utilization.
•  A study published in Medical Care found a 2.5 visit reduction in ER and outpatient visits per participant over two years, and a 0.49 day reduction in hospitalizations in the first six months.
•  Another study published in Effective Clinical Practice of CDSMP participants found that, over a one-year period, participants had a mean 0.97 day reduction in hospitalization and averaged 0.2 fewer ER visits. This suggests an estimated savings of about $1,000 per participant in the first year.

In 2009, $32.3 million was provided for CDSMP as part of the American Recovery and Reinvestment Act (ARRA) $650 million Prevention and Wellness Fund. The ARRA funding was for a two-year period ending March 2012. Allocations from the PPHF included: $10m in FY12; $7.1m in FY13; $8m in FY14; and $8m in FY15. So far, over 256,000 individuals have participated in CDSME programs. NCOA recommends that CDSME funding for FY16 be restored to 2010 and 2011 levels of $16 million, which permitted 47 states to be funded. This ARRA-level funding will enable an increasing number of states to make CDSME available to those who can benefit, beyond the 22 states currently offering these important programs.

A number of evidence-based programs are now available which can reduce falls and save money. When compared with controls, the Tai Ji Quan: Moving for Better Balance intervention reduced falls by 55%; the Stepping On program reduced falls by 30%; and the Otago Exercise Program reduced falls by 35% when delivered to adults 80 years of age and older A Journal of Safety Research special report from the CDC titled: “A cost-benefit analysis of three older adult fall prevention interventions” found that:

•  The Otago Exercise Program had an average cost per participant of $339.15, an average expected benefit of $768.33 for participants over age 80, and a return-on-investment (ROI) of 127% for each dollar invested for this group.
•  Tai Ji Quan: Moving for Better Balance had an average cost per participant of $104.02, an average expected benefit of $633.90, and an ROI of 509% for each dollar invested.
•  Stepping On had an average cost per participant of $211.38, an average expected benefit of $345.75, and an ROI of 64% for each dollar invested.

In addition, in the November 2013 CMS Evaluation of Community-based Wellness and Prevention Programs analysis found that participation in the A Matter of Balance (MOB) falls prevention program was associated with a $938 decrease in total medical costs per year. This finding was driven by a $517 reduction in unplanned hospitalization costs, a $234 reduction in skilled nursing facility costs, and an $81 reduction in home health costs.

The Senate Appropriations Committee proposed in FY12, FY13, and FY14 to allocate $10 million for elder falls prevention in the PPHF. The final FY15 appropriation package included $5 million. NCOA recommends funding of $10 million for elder falls prevention under the PPHF for FY16, consistent with previous Senate Appropriations Committee proposals.

Patricia G. Barnes

Age Discrimination in Employment

5/28/2015 11:27:46 PM

Policy makers should start thinking about healthy aging long before an individual becomes a "senior citizen" or needs some kind of institutional care.

The problem begins when workers are in their 40s and 50s and become subject to age discrimination in employment, which robs millions of older workers of the ability to save money for a financially secure retirement.

Significant research shows that unemployed older workers forgo needed health care and suffer from health-harming depression and anxiety.

Moreover, according to the Economic Policy Institute, 48 percent of older Americans are economically vulnerable. Many cannot afford needed medications. Most private sector workers lack a defined benefit pension and have been unable to save enough to finance a secure retirement through 401 (k) savings plans. Millions of older Americans were unable to recover from job loss, home foreclosures and the loss of investments during the Great Recession. And they continue to suffer today because they cannot find decent work due to systemic and unaddressed age discrimination in employment. (See my book, Betrayed: The Legalization of Age Discrimination in the Workplace)

It is my hope the White House Conference on Aging will consider the impact of age discrimination in employment on healthy aging in the weeks ahead.

llgeorges@analprez

5/30/2015 10:27:53 PM

HEALTHY AGING? First thing that should be considered to keep your hands off of our Social Security and Medicare benefits!

Hanson Chang

Reassure Analytics

5/31/2015 5:34:34 PM

Why aren't technology solutions discussed as opportunities to maintain social engagement, encourage health living, and help Americans age in place?

Paraphrasing what Peter Thiel (billionaire and founder of Paypal) made an interesting point in his book that government used to partake in massive development that helped build the future in America. We've traded projects like the Interstate Highway System and the NASA Apollo that came with definite planning, to Medicare and Social Security that focuses only at an indefinite future.

What technology solutions can we develop and promote today that will curb the need (or at least reduce the need) for Medicare as Americans age?

That's what we're focused on at www.reassureanalytics.com.

Hanson Chang

Reassure Analytics

5/31/2015 5:36:11 PM

Sarah Szanton

Johns Hopkins University

6/1/2015 8:58:44 AM

I commend the White House Conference on Aging for its efforts to redefine aging by focusing on opportunity and maximizing independence and well-being. Innovative programs that address the interaction between the home environment and the older adult’s physical function not only have the potential to help Americans live safely and comfortably in their homes as they age but can have effects on chronic disease, mood, and quality of life. Preliminary findings from the Community Aging in Place –Advancing Better Living for Elders (CAPABLE) study, a client-centered home-based intervention to increase mobility, functionality, and capacity to “age in place” for low-income older adults, help make the case for replicating CAPABLE nationally as a package for low-income older adults.

The combination of a nurse, an occupational therapist and handyman repair is cutting in half dually eligible older adults’ functional difficulties. This is a much stronger effect than other disability programs and we believe the combination is key. The nurse, for example, addresses pain, mood, strength, balance, medication complexity and primary care provider advocacy/communication. If the older adult has significant leg weakness, assessing the stairwell for banisters and having a handyman install them on each side can improve functionality, and subsequently the amount of exercise the older adult gets which can have effects on chronic disease, mood, and quality of life.

Encouraging Medicare Advantage plans, Accountable Care Organizations, and Duals Special Needs Plans to incorporate CAPABLE or elements of it into their models has the potential to help meet the “triple aim.” Medicare could separately have a bundle of services for complex patients under a certain income limit such as 200% of the Federal Poverty Level. One of these evidence based services could be CAPABLE. Medicare should also allow the Annual Wellness Visit to be conducted in the home regardless of whether the older adult is homebound and consider limited home repair that improves functionality as preventive health care.

For more information and preliminary findings from CAPABLE visit:
nursing.jhu.edu/.../proving-capable

Jonathan Black

6/1/2015 9:32:04 AM

I may have missed it, but I am disappointed not to see in the policy brief any reference to the extensive Village Movement (http://www.vtvnetwork.org) now growing beyond 600 communities. This is a non-governmental, self-orgainizing co-op movement to make it easier for the healthy aging to age in place.

Susan Maloney

Edinboro University

6/6/2015 2:04:47 PM

Healthy aging efforts aimed at prevention and empowering self-care management versus disease focus creates a more hopeful environment for positive change; thank you for these White House Aging policy efforts.
Regarding nutrition specifically, continued linking of services for older adults such as meals on wheels and local farm to market subsidized food service is an area that increased funding can impact significant change.

Dr. Cheryl Townsend Winter

WA State Council on Aging

6/8/2015 12:15:55 PM

The Washington Association of Area Agencies on Aging (W4A) and the Washington State Council on Aging (WASCOA) have explored the issue of healthy aging for older Americans and identified the following priority recommendations:

•  IMPROVE PHYSICAL FITNESS: Ensure access to appropriate evidence-based exercise options at every level of physical ability, made affordable by Medicare and/or private insurance plans. Study why older adults don’t exercise regularly and develop/test programs to increase participation. Emphasize strength and balance for falls prevention.

•  IMPROVE BEHAVIORAL HEALTH SUPPORTS: Expand community-based mental and behavioral health services, including geriatric mental health, substance abuse, and traumatic brain injury. Fund prevention programs that reduce medication misuse, depression, and suicide. Expand funding for Alzheimer’s research, treatment and support.

•  IMPROVE NUTRITION SUPPORTS: Ensure funding and access to healthy, nutritious and culturally appropriate foods, plus nutrition education that includes community kitchens and dining programs. Encourage coordination of food programs to reduce food insecurity for all. Educate health care and social service providers on the social determinants

•  IMPROVE COMMUNITY MOBILITY AND TRANSPORTATION: Ensure access to transportation and mobility resources that promote successful aging in place, in urban, suburban and rural areas; by promoting “complete streets” and multiple modes of community mobility, including transit, pedestrian, bicycle, and assistive technology (wheelchairs, walkers, etc.); by developing technologies and partnerships to support access to transportation and mobility resources and by reducing funding silos for transportation and mobility services.

•  IMPROVE HOUSING OPTIONS:  Ensure access to safe, affordable housing in viable condition that allows for aging in place and by promoting universal design code requirements to ensure construction of accessible housing for all ages and abilities. Promote affordable, accessible housing through requirements for government-funded projects and encouragement to developers/builders through tax incentives and refundable tax credits.

•  IMPROVE COMMUNICATION AND DIVERSITY: Ensure access to housing, health and human services for all people regardless of culture, ethnicity, sexual orientation, gender or health status. Educate providers to understand cultural norms. Develop policies and programs to fully address health disparities. Make sure policies are flexible and fully inclusive. Meet or surpass the CLASS national standards in health care.

Some additional considerations include: Expand all public insurance to include adequate preventive health benefits for hearing, vision and dental services; emphasize the development of refundable tax credits for accessibility modifications to existing homes; promote programs that focus on community engagement opportunities for older adults, including employment opportunities for older adults who want to continue contributing as part of the paid workforce;
promote programs that emphasize companionship as a way to avoid social isolation; promote programs that emphasize being prepared for emergencies and the importance of knowing your
neighbor during such times.

Melanie McNeil

Georgia State Long-Term Care Ombudsman

6/8/2015 4:20:03 PM

On behalf of the Systems Advocacy Committee of the National Association of State Ombudsman Programs, our comments to the discussion questions include:

We often overlook the gold mine of experiences and talents of individuals who live in our communities in facility settings – either nursing homes or board and care homes. Individuals in these settings should be included in intergenerational activities – if the individuals are not able to go to the schools to volunteer, bring the students to them. Seniors can serve as mentors, crises counselors, life coach counselors, tutors, role models, oral history subjects to the next generation and both sides will benefit, but someone needs to bring the two together. Volunteering improves physical and mental health in older adults, and reduces the risk of depression, regardless of where a person lives. While the challenges of volunteering from a facility exist, the challenges are not insurmountable and need to be part of our plan for aging.

Tiffany Matthews, Founder & CEO

Live BetterBoomer! Healthcare Access & Advocacy Services

6/10/2015 12:14:29 AM

Quite frankly, I am very surprised to see that there is no mention of helping people, mainly baby boomers and the newly insured through the Affordable Care Act, with managing their healthcare. I am a healthcare advocate with chronic conditions and at times it is difficult for me to decipher and remember all of my appointments, insurance benefits, manage my medications and handle my conditions while living an actual life and focusing on the things I would like to enjoy.

Having been a social worker for 20 years in hospitals and nursing homes, I have met thousands of people that have no idea what to do or where to begin when a healthcare crisis arises. They have no idea where to find information, they have no clue what questions to ask, and they have little hope of what results to look for.

When I think of healthy aging, I think of ways and methods that include not only preventive care, but I think of methods that I can use along with my healthcare providers to maximize my treatment, as well as my treatment during my treatment.

Millions of patients believe that they lose their health care power once they put that ghastly patient robe on for an appointment or a hospital stay. My view and the mission of my business is to make it so that people are assured through training and support that no matter how vulnerable they feel, that they can exercise there patient rights and live up to their patient responsibilities.

When it comes to healthy aging, knowledge is power, especially where their healthcare is concerned. Patient advocacy can save the patient, insurance companies, health care systems, and our government millions of dollars by eliminating duplicate and unnecessary appointments, medications and other treatments as well as the time, money and stress for the patient that goes along with them.

I have spoken to hundreds of people about this advocacy topic and they agree that this is something that is terribly needed especially by older adults and their caregivers. Advocacy definitely needs to be a part of the conversation in any discussion about aging, caregiving or healthcare.

Joann M. Montepare

RoseMary B. Fuss Center for Research on Aging and Intergenerational Studies, Lasell College - Village, Newton MA

6/10/2015 11:34:48 AM

A critical component missing in the Healthy Aging discussion is the role of higher education. Despite a recognition of shifting age demographics and their implications, students graduating from college enter their personal and professional worlds with no or negligible information about aging! Moreover, our institutions continue to mount curricular initiatives more aligned with the needs and interests of an age-segregated than an age-diverse population – which is fast becoming one that includes older learners looking toward higher education for new or advanced training and/or lifelong learning opportunities. The last WHCoA called for a mini-conference on Aging and Education which is now needed more than ever to examine how higher education can better promote gerontological literacy and the educational needs of our aging population. And, we must not overlook the role that older adults can play in addressing challenges faced by many institutions of higher education (e.g., student dropout, deficient literacy in math, reading, writing, etc.). We need to consider seriously how older adults that constitute the new stage of life between midlife and old age offer a largely untapped resource in meeting our educational challenges by way of their expertise and connecting the generations. Moreover, a call to action for older adults in higher education would provide new opportunities for work (paid and unpaid) sought by a growing number of talented older adults looking to stay engaged and "give back" - which in turn would strengthen the link between purpose and improved health/longevity - a core goal of the WHCoA healthy aging vision.

Marcus Harazin

Albany Chapter New York StateWide Senior Action Council

6/11/2015 1:09:45 PM

The health of older persons hinges primarily on lifestyle choices including diet, exercise, preventive care, good mental health and the ability to self manage chronic disease.  Most older persons experience multiple chronic conditions.

Federal policy should integrate chronic disease detection and prevention initiatives rather than taking  a disease specific approach.   Hospitals, insurers, and health care providers should be required to provide access to self management and prevention programs such as Chronic Disease Self Management, Diabetes Self Management , Diabetes Prevention, falls prevention and other key evidence based approaches.

Medicare preventive exams and tests are woefully underutilized. CMS should be required to set state and county goals for the use of Medicare Preventive Screening Tests.   Data on the use of preventive tests should be provided for Medicare Beneficiaries in both the fee for service and managed care system so that  communities can work together to reach underserved populations.
Congress should fix eligibility criteria to assure that Medicare Part A and Medicare Advantage Plans will pay for follow up rehab care for any beneficiaries who have been in a hospital bed for three midnights regardless of time spent in observation status.

The current system of payment for health care should be organized into a single payer system to reduce duplication and promote comprehensive health care delivery for people of all ages.

Doug Dickson

Encore Boston Network

6/12/2015 12:24:26 AM

First, thanks for creating this opportunity.

I appreciate the challenge of selecting issues and shaping an agenda for a conference of this nature that happens just once every ten years. And all of the issues on the table for this conference are certainly justified, all the more so because of the huge demographic shift toward a growing population of adults 50+.

But my fear is that in these conversations, we will focus solely on the deficits, challenges and needs of an aging population and overlook the potential of this group to contribute solutions to these and other social problems. These are two sides of the same coin: many older adults are at risk and need our support, but many are in a unique position to use their skills, experience and wisdom to benefit their communities, address societal needs and create value far beyond the drawdown of resources we hear discussed so alarmingly in the media and public discourse.

I suggest that one of the themes coming out of this conference should be how we as a nation can harness the energy and enthusiasm of older adults with time and talent, and remove the barriers to their interest in working and serving in social purpose roles. A clear statement that we recognize and value this resource would be an important start. Raising awareness of the biases that stand in the way of our ability to fully engage this population is another important step.

Assessing our language and the extent to which it demeans and isolates older adults is a related issue. We can't embrace and elevate this talent pool by continuing to call them "seniors," by reinforcing negative stereotypes with references to "senior moments," or by failing to acknowledge that most of the declines we associate with aging result from lifestyle decisions and can often be reversed. We also need to look at policy issues, such as those related to the workplace, and incentives for organizations to hire or retain older workers.

As people grow older, they become more conscious of the world around them and more motivated to leave it in better shape than when they arrived on the scene. This is both a product of maturity and an inherent component of legacy. Why are we not anxious to capture this naturally occurring resource? Why are we willing to let it go to waste, especially in an era of constrained social spending and limited capacity to address huge issues like obesity, poverty, climate change and so many more.

By failing to tap this reservoir of knowledge and experience, we are in effect saying that we are willing to leave legitimate options on the table, forego the opportunity to improve the lives of our people, and consign a growing segment of our society to lives of insignificance. We know that lack of engagement and purpose are associated with health problems and shortened lives. Healthy aging means, above all, finding a place of value and contribution for older adults in our society.

I have worked closely with organizations like Life Planning Network, Discovering What's Next, Executive Service Corps, ReServe, Encore.org, Encore Network and Encore Boston Network to help people find opportunities to work and serve in substantive social purpose roles. But as successful as these initiatives are, they are reaching a small fraction of those who could benefit from them. We need to scale these efforts, which requires top-down advocacy as well as bottom-up support. It also requires new attitudes throughout the public and private sectors about the potential and the benefits of leveraging this important human resource.

If we miss the chance to make this an outcome of this year's White House Conference on Aging, our task of building encore work opportunities -- second acts for the greater good -- will be harder and slower to scale. A boost from the WHCOA will change the receptiveness for our efforts by calling attention to the possibilities of age, not just the challenges. We see age as an asset, for individuals, for communities and potentially for our society.

Jennifer Dexter

Easter Seals

6/12/2015 12:31:39 PM

Transportation plays a vital role in a person’s overall health. Unfortunately, this intersection is often overlooked. From the health benefits of walking— people who take transit walk more—to the reduction of depression, transportation options are important to wellness. Transportation plays a critical role in determining the degree to which older adults, persons with disabilities and low income individuals will be able to participate in the workforce, contribute to their communities, access healthcare, continue social connections, and help reduce hospital re-admissions. A critical component to maintaining the health and wellbeing of Americans is their ability to access healthcare. The lack of access to non-emergency medical transportation (NEMT) is a critical barrier to the management of chronic illness and disabilities.

As the population continues to age, health and transportation are integral ingredients to the recipe for aging in place. Research is beginning to show some relationships where the wellness of the recipients of federal funding is improved due to better access to transportation choices in their communities. This increased health and wellness of citizens is not only increasing their quality of life, but it is also good for the communities in which they live and may help significantly reduce government expenditures for care and support. We need to understand how transportation access achieves community living objectives and helps improve and maintain the health of some of the most vulnerable citizens.

Jennifer Dexter

Easter Seals

6/12/2015 12:49:33 PM

Access to home and community-based services is critical to healthy aging. This is true not only because of the direct services and supports that participants receive but also because of the long-term healthy aging benefits. HCBS providers are well positioned to monitor health and well being, implement evidence-based healthy aging interventions and provide caregiver supports for cognitive and physical health. By supporting HCBS providers in these activities, we will have better health outcomes and a more supported caregiving network.

Alan K. Parver

Healthcare Nutrition Council

6/12/2015 1:20:37 PM

The Healthcare Nutrition Council (HNC) commends the 2015 White House Conference on Aging (WHCOA) for issuing a thoughtful policy brief on healthy aging that reflects the growing recognition of the importance of nutrition in maintaining good health and preventing disease and injury.  Maintaining functionality is particularly important to maintaining independence for older adults.  Since malnutrition is a risk factor for frailty, HNC recommends that the WHCOA urge the Centers for Medicare & Medicaid Services (CMS) and other federal agencies to conduct regular outreach and educational efforts and implement policies that encourage providers to identify and treat disease-related malnourished patients, as well as patients at risk of disease-related malnutrition from chronic diseases, in a timely manner.  Specifically, providers should be encouraged to routinely screen patients for disease-related malnutrition and for risk of disease-related malnutrition – both in institutions and in the community – and provide follow-up assessments and timely nutrition interventions for distinct nutrient requirements when indicated.

Malnutrition is generally defined as “an acute, subacute or chronic state of nutrition, in which varying degrees of overnutrition or undernutrition with or without inflammatory activity have led to a change in body composition and diminished function.”  There are three types of nutrition diagnoses for adults in clinical practice settings: (1) starvation-related malnutrition; (2) chronic disease-related malnutrition; and (3) acute disease or injury-related malnutrition.   In these comments, we refer to both chronic disease-related malnutrition and acute disease or injury-related malnutrition generically as disease-related malnutrition.  Disease-related malnutrition has similar distinct nutrient requirements altered in both obese (overnourished) and undernourished patients.

Disease-related malnutrition is a critical, complex problem affecting elderly individuals in all settings of care.  Recent studies estimate that 17 percent to 57 percent of geriatric patients in hospitals and nursing homes have evidence of malnutrition, and 20 percent of patients in the acute hospital setting consume less than half of their daily nutrient requirements.  Approximately 10 percent of patients with chronic illness in the community and between 30 and 50 percent of patients admitted to hospitals have disease-related malnutrition.  Importantly, a high prevalence of elderly individuals also are at risk for malnutrition.

Older adults who are malnourished are at risk for a number of adverse outcomes that impact their ability to stay independent and in their local communities:

•  Morbidity, Complications and Mortality: Malnourished patients are more likely to experience complications, such as pneumonia,  pressure ulcers,  nosocomial infections  and death.  In addition, malnutrition is a risk factor for other severe clinical events, such as falls  and worse outcomes after surgery or trauma.   Malnutrition has a negative impact on patients with specific chronic diseases and conditions, such as stroke patients, and patients with heart failure, cancer or chronic obstructive pulmonary disease.

•  Length of Stay:  Malnourished patients, as well as patients at risk for malnutrition, have significantly longer hospitalizations than well-nourished patients and patients not at risk for malnutrition.  Similarly, malnourished patients in sub-acute care facilities have longer lengths of stay than patients who are nutritionally at risk.

•  Readmission, Institutionalization and Ongoing Services:  Disease-related malnutrition is a common reason for patients to be readmitted to hospitals. One recent study found that malnourished patients with heart failure were 36 percent more likely to be readmitted to the hospital within 30 days than nourished patients with heart failure.   Additionally, hospitalized patients at risk of disease-related malnutrition are more likely to be discharged to another facility or require ongoing healthcare services after being discharged from the hospital than patients who are not at risk for malnutrition.

•  Health Care Costs:  Disease-related malnutrition increases the cost of care due to the factors described above: increased morbidity, complications and mortality, longer hospitalizations, and more re-admissions, continued institutionalizations and ongoing health care services.  A 2014 study estimates that the annual burden of disease-related malnutrition in the community across eight diseases was $156.7 billion.  The authors hypothesize that their findings likely underestimate the total burden of malnutrition since its rates are much higher in hospitalized patients.   The cost impact of untreated malnutrition is illustrated below:

o  Costs Related to Increased Morbidity and Complications:  High-risk malnourished patients are 2.1 times more likely to develop pressure ulcers than well-nourished patients.   One study cited the average cost for hospital treatment of a stage IV pressure ulcer acquired in the hospital (including the treatment of associated medical complications) to be $129,248.  The average cost of hospital treatment of a stage IV pressure ulcer acquired in the community (including the treatment of associated medical complications) was $124,327.

o  Costs Related to Hospitalizations:  Hospitalized malnourished patients, patients at risk for malnutrition and patients who experience declines in their nutritional status while hospitalized have higher health care costs than well-nourished patients, patients not at risk for malnutrition, and patients who remain properly nourished during their hospitalizations, respectively.

o  Costs Related to Readmissions:  Clearly, malnourished patients and patients with nutrition-related or metabolic issues are frequently readmitted to the hospital.  Studies have demonstrated that readmissions are 24-55 percent more costly than initial admissions and account for 25 percent of Medicare expenditures.  One study found that there were 11,855,702 Medicare fee-for-service patients discharged from hospitals between October 1, 2003 and September 30, 2004 who were at risk for rehospitalization; 19.6 percent of the patients were readmitted within 30 days, resulting in a cost of $17.4 billion.

Despite its common occurrence and significant negative impact on patient health, disease-related malnutrition often remains undiagnosed both in the healthcare institution and in the community.  This is especially unfortunate since there are several validated screening and assessment instruments that providers may use to determine patients’ nutritional status.   Providers can identify disease-related malnourished patients, as well as patients at risk for disease-related malnutrition by incorporating systematic nutrition screens into their regular practices – such as in Medicare annual exams -  and providing follow-up assessments where indicated.

Timely, appropriate clinical nutrition therapies can improve or maintain patients’ nutritional status, and result in less morbidity and fewer complications, shorter hospital stays, fewer hospitalizations, reduced hospital readmissions and savings.  For example, oral nutritional supplements (ONS) for hospitalized patients are associated with reductions in hospital lengths of stay, admission rates and costs.    Specialized nutritional products designed to meet the unique nutritional needs of major surgery patients with distinct nutrient ingredients have been proven to significantly reduce post-operative infectious complications which include nosocomial pneumonia, surgical site infections, anastomotic leaks, and urinary tract infections.  Despite these benefits, utilization has been low among hospitalized patients since providers are not incentivized under the Medicare fee-for-service payment model to furnish ONS to these patients.

WHCOA can advance healthy aging and help older adults to better manage their chronic conditions, optimize their health and prevent injury by urging nutrition screening for disease-related malnutrition, nutritional assessments and timely, appropriate nutritional therapeutic interventions.  This can be accomplished by establishing federal and state malnutrition goals as well as integrating nutrition screening and intervention into healthcare delivery systems, payment models, and healthcare quality measures in public and private accountability programs.

References available upon request.

Mary Beth Arensberg, PhD, RDN

Abbott Nutrition, Division of Abbott

6/12/2015 3:36:43 PM

Nutrition is pivotal to many government programs for older adults and we believe it will play an even greater role in the coming decade, particularly in helping keep older adults independent and in their own communities as they age.

The WHCOA Healthy Aging brief includes nutrition in the context of a healthy diet and the need for increased support for meals program and Supplemental Nutrition Assistance Program benefits for at-risk populations.  We agree such support is important.  Further, we believe equal attention should be given to the identification of and treatment for disease-related malnutrition, a critical problem affecting older adults across the continuum of care.  A primary reason that malnutrition remains an issue is that it is not a part of public health goals, nor is it a standard of medical care.

To support Healthy Aging, we recommend these specific actions:
•  Make malnutrition a key indicator of older adult health
•  Re-examine older adult goals of Healthy People 2020 and build in a stronger emphasis on malnutrition identification, prevention, and intervention
•  Address sarcopenic malnutrition in national and state obesity plans
•  Re-examine the protein requirements of older adults and consider the need for an increased protein Dietary Reference Intake for older adults.

In January of this year, the WHCOA joined the Academy of Nutrition and Dietetics and the National Association of Nutrition and Aging Services Programs in a national listening session, Nutrition = Solutions to Healthy Aging and Long-term Services and Supports. During the session we learned that:
•  Malnutrition impacts can include:  increased risk of infection, longer length of hospital stay, functional limitations, increased medical complications, increased rate of hospital readmissions, higher care costs, and decline in cognition and mental health
•  Caregivers often have limited knowledge and skills to provide adequate nutrition
•  Most care transition models lack a nutrition component, even though there is evidence that nutrition helps reduce readmissions
•  There have been limited quality improvement efforts in the U.S. to address malnutrition care
•  Malnutrition care is further inhibited by a lack of robust quality measures
•  A national malnutrition quality improvement initiative has been launched that aims to address gaps and barriers to quality care.

Malnutrition negatively impacts those with specific chronic conditions and is a risk factor for falls and poorer health outcomes, making malnutrition a patient safety risk.  Sarcopenia, which is defined by loss of muscle mass and can increase protein needs, has become a new public health problem for older adults—even among those who are overweight or obese.  And this loss of muscle mass puts older adults at risk for disabilities and complications. Yet there are effective malnutrition interventions available, like oral nutrition supplements, which have been shown to decrease the probability of hospital readmission and reduce length of stay and costs among older adults.

2015 is a historic year for programs that provide support for older adults, with the Older Americans Act, Medicare, and Medicaid each commemorating their 50th anniversaries and Social Security commemorating its 80th anniversary. We commend the WHCOA for their work to celebrate these programs and define the issues that will help shape the landscape for older Americans in the next decade.  We specifically recommend a larger focus on nutrition, as well as malnutrition care, as these are issues of primary importance for the independence and longevity of older adults.

Mary Beth Arensberg, PhD, RDN
Director of Health Policy
Abbott Nutrition Division of Abbott

Jillanne Schulte, JD

American Pharmacists Association

6/12/2015 3:47:02 PM

The American Pharmacists Association (APhA), the nation’s largest and oldest professional organization representing pharmacists providing care across all practice settings and the National Alliance of State Pharmacy Associations (NASPA), representing all state pharmacy associations, commend the Administration for highlighting high-quality, patient-centered health care as an essential element for healthy aging.

The WHCOA’s Healthy Aging policy brief touches on the importance of preventive health services, chronic condition management, and injury prevention to the well-being of older Americans.  In response to WHCOA’s first discussion question (“What do older adults and their families need to manage their chronic conditions and to optimize their physical, cognitive, and behavioral health?”), APhA and NASPA have several suggestions to enhance ongoing efforts to improve services in these three essential areas:

•  Preventive Health Services (p. 2):  We encourage the Administration to increase older Americans’ access to preventive health services by allowing qualified and accessible health care providers, like pharmacists, to provide these services in government programs like Medicare.  The shortage of primary care providers is expected to worsen, which will only make the accessibility to non-urgent care like preventive services more difficult, particularly for those who are already medically underserved.  Pharmacists are among the most accessible clinicians and can provide a wide range of services, including certain preventive services such as health and wellness testing and immunization administration, as well as chronic disease management and care coordination during care transitions.  Currently, with some limited exceptions, Medicare Part B does not allow beneficiaries to receive these services from their pharmacist, a professional with whom they already have a trusted relationship.  This unnecessarily restricts patients who are in need of care from access to valuable services that pharmacists can provide, and limits the opportunity to increase beneficiary participation in services like Medicare's Annual Wellness Visit.  Given that more than 90% of Americans live within 5 miles of a community pharmacy, fully utilizing pharmacists for vital services will improve access to quality care for older Americans, increasing the likelihood that they will receive preventive care.

•   Chronic Condition Management (p. 3):  Proper medication management plays a significant role in health outcomes for patients with chronic conditions.  As the medication experts on the health care team, pharmacists are uniquely situated to ensure that patients understand their medications and the importance of adherence to care regimens.  APhA supports efforts to improve patient self-management, but encourages the Administration to supplement these self-management programs with the expansion and enhancement of medication therapy management (MTM) programs for Medicare patients.  Currently, only about a quarter of Medicare beneficiaries are eligible for MTM services in the Part D program and the actual utilization rates are far lower.  Variation in Part D plans’ MTM eligibility criteria creates confusion for providers and beneficiaries alike and simpler, consistent criteria would create clear eligibility parameters that would likely lead to more consistent utilization and, correspondingly, increased benefits to beneficiaries.  Likewise, because pharmacists are not recognized as Medicare providers, many are precluded from participating in team-based care models where they could contribute to managing chronic conditions and the medications associated with them.

Access to medication management services provides an opportunity for patients with chronic conditions to sit down with medication experts who can assess all of their medications (including for falls prevention), work with other health care providers to address problems, answer questions, and better prepare them to manage their medications.  By providing patients with baseline knowledge, expanded and enhanced medication management programs could further bolster the Administration’s efforts to improve patient self-management.

Additionally, as the Administration considers options for improving chronic condition management, we encourage a closer examination of barriers that can adversely impact care coordination for patients with chronic conditions.  As noted above, medication management is an essential element of chronic care management--yet pharmacists, who have more medication-related education and training than any other health care provider, often face barriers to full participation in emerging integrated care delivery models.  Specifically, pharmacists lack full access to health information technology systems and government programs limit patient access to pharmacists for many health care services.  If these issues are remedied, pharmacists will be able to work with other health care providers to provide patients more effective, efficient, and coordinated care.  Such integration will help prevent disease complications associated with asthma, chronic obstructive pulmonary disease, diabetes, congestive heart failure, and other chronic diseases, which lead to increased health care utilization and escalation of total health care costs.

•  Preventing Injury (p. 3):  APhA commends the Administration’s work on fall prevention and encourages additional investment in research on older patients who take medication that increases the risk of falls (e.g., antidepressants).  Recent preliminary research results indicate that when pharmacists intervene with patients on these drugs, risk of injury due to a fall decreases.  Considering the high toll of falls, we believe placing an additional focus on researching the impact of pharmacists’ intervention is warranted. We also recommend that successful falls prevention practices and programs be highlighted and shared among health care professionals, and that incentives be developed to increase uptake of these practices in the marketplace.

In response to WHCOA’s second discussion question (“How can we ensure that older adults know about, and take advantage of, the preventive services available to them under Medicare?”), while APhA and NASPA cannot comment extensively, we do suggest expanding provider education programs regarding MTM programs and other services and allowing provider referrals (including both physicians and pharmacists) for MTM services.  We have heard from our members that many patients are hesitant to take advantage of services that are not directly offered to them by a known provider (e.g., services offered via phone calls).  Thus, if services are offered or suggested by a trusted provider, older adults may be more likely to utilize them.

APhA and NASPA thank the Administration for its efforts to promote healthy aging and for the opportunity to provide our input.  We look forward to continuing to work with the Administration and other stakeholders to improve patient care quality and outcomes.

Monica Schaeffer, Ph.D.

VITAL, Inc. (www.vitalinc.org)

6/12/2015 5:38:16 PM

On April 21, 2009 President Obama signed into law the Edward Kennedy Serve America Act. This Act was designed to not only expand opportunities to serve but build the capacity of individuals, nonprofits, and communities, and encourage innovative approaches to solving key societal problems. The Act also called for silver scholarships to be awarded to those who volunteered. These scholarships could then be used for the continuing education of the volunteer, his/her children, or grandchildren. In honor of the 2015 WHCOA, the country should demand funding of this Bill that would promote the assets of the 78 million baby boomer generation, promote heathy aging, and be a catalyst for social innovation creating new pathways for service that younger generations could look forward to as well when they reached their "dividend" or "encore" years.

Deborah Socolar, MPH

6/12/2015 8:31:29 PM

I write both as a public health professional (health care policy) and as the widow of a man whose neurological disabilities were greatly compounded for his last 7 years by the effects of a brain injury suffered in a 2006 bathroom fall.

I have several wide-ranging suggestions for various public policies, all to reduce the risk of harm from fall injuries – starting with one aimed at individuals and moving on to policies for the community and the medical world:

1)  First is a simple tip that should be widely shared to reduce both the risk of falls and the harm caused if someone does fall.  For safety, people should undress and dress in a bedroom (even before and after bathing), not in the bathroom.  Some people may change in the bathroom for privacy, but everyone should be urged to avoid that and simply use a robe or such – so that they can sit on a bed or chair to put on or take off pants, avoid trying to dress on a slippery floor, etc.  I have never seen this included in any of many lists of tips to prevent fall injuries at home.

2)  Besides pursuing fall prevention, this nation needs more study of and attention to ways of diminishing the harm caused when people do fall at home. The UK, for example, apparently has investigated and experimented with various types of resilient flooring when designing or adapting homes for seniors. (See, for example, www.rospa.com/.../...ng-reducing-hip-fractures.pdf) Can rubber, cork, or padding under vinyl reduce injury risk? Would a fall in a fiberglass tub be less likely to fracture a skull than a fall in a cast iron/porcelain/marble tub? Wouldn’t bathroom vanities/fixtures with rounded edges help diminish some impact injuries?

3)  Improved Medicare coverage of visions and hearing care could help reduce falls and other injuries, and their associated costs.

4)  Current penalties and other fall-related policies for Skilled Nursing Facilities and other health care facilities are probably making them less willing to admit the patients most at risk of falls.  Even in 2006, we were advised that SNFs would be reluctant to accept my husband (from acute rehab) because the cognitive effects of his brain injury meant that he didn’t grasp or retain that he shouldn’t attempt to stand on his own. So he was restrained for a time with a wheelchair seatbelt, partial bed rails, and bed and seat alarms. That probably was a significant reason why it took weeks to find a SNF that would admit him.  With all the penalties, scorecards, and the like added since then, the problem has likely multiplied, depriving some hospitalized patients of the opportunity for rehab, and boosting expenditures on hospital care.

5)  One important way of combating osteoporosis early seems little noticed. Patients who are prescribed what may be a long or life-long course of medications that increase the risk of osteoporosis (for example, carbamazepine) should be advised of that risk early, encouraged to reduce it through diet and weight-bearing exercise, and monitored by their physicians – without waiting till they are seniors for such attention.  My late husband was on carbamazepine for over 20 years without anyone mentioning the osteoporosis issue until he saw an astute VA primary care MD.  Since some patients’ primary care is unfortunately fragmented, however, the prescribing doctors (in this case, neurologists) should be expected to at least flag the issue.

6)  Finally, to reduce the risk of seizures -- and attendant fall injuries – there is urgent need for the Food and Drug Administration to continue investigations and action to ensure true equivalence in the bioavailability and absorption of generic versions and brand-name versions of anti-seizure medications.  Again, I draw from my husband’s sad experiences – but I know that this is an issue of concern to many patients with seizure disorders, and their physicians.  The American Academy of Neurology position statement opposing mandatory generic substitution (graphics8.nytimes.com/.../aangenerics.pdf) came too late in 2006 to benefit my husband. After 10 years seizure-free, my husband began having seizures shortly after switching versions when his insurance changed (and one of those seizures occurred in the bathroom, so falling meant a brain injury that altered his life drastically forever). Years later, when one generic maker’s version replaced another generic, as we changed pharmacy, his measured blood levels of the drug dropped by nearly half in just a week.  This is too crucial an issue for too many patients to be satisfied with narrowly-framed, limited studies (for example, http://www.medscape.com/viewarticle/836222) and continued FDA inaction.

Thank you for the opportunity to submit these comments.

Amy Gotwals

n4a

6/12/2015 8:33:28 PM

Submitted by the National Association of Area Agencies on Aging (n4a), www.n4a.org

In order to achieve many of the goals outlined in the WHCOA Health Aging policy brief, including managing chronic conditions; optimizing physical, cognitive and behavioral health of older adults; and helping people live safely and comfortably in their own home and stay engaged and connected to their communities as they age, we believe the following recommendations should be a priority of the Administration and Congress.

•  Improve Care Transitions and Care Coordination by Better Integrating the Aging Network and Community-Based Organizations: AAAs have demonstrated their ability to partner effectively with health care systems and state quality improvement organizations to administer care transition programs that result in seamless transitions for consumers from acute care settings to home. This results in improved health outcomes and fewer re-hospitalizations.

Recommendation: n4a encourages the Administration and CMS to explore options to make care transitions activities reimbursable under Medicare and incentivize hospitals to work with AAAs and other community-based organizations to more efficiently and safely facilitate patient transitions from acute health care settings back to the community and home.

Recommendation: n4a encourages CMS’s Center for Medicare and Medicaid Innovation to seed new partnerships between the medical community and the Aging Network to recognize that the majority of health happens at home and in the community. Specifically, we recommend that a role for AAAs and community-based organizations be more specifically included in CMMI pilots around models such as Medical Homes, Medicaid Health Homes and new demonstration projects that better coordinate care to dually eligible individuals.

The Affordable Care Act (ACA) established the Community-based Care Transitions Program (CCTP) to improve care for high-risk Medicare beneficiaries being discharged from the hospital to prevent unnecessary re-hospitalizations and avoidable health care costs. To receive funding from the program, which is administered by CMS as part of the Partnership for Patients, community-based organizations must partner with hospitals. AAAs have taken the lead in this initiative: AAAs played a key role in approximately 90 percent of sites. More than 100 AAAs received initial CCTP funding.

However, n4a has serious concerns regarding how CCTP site performance was measured and evaluated by CMS. n4a is concerned that readmissions and enrollment metrics used to reflect program performance do not adequately or accurately capture site performance or impact.

Recommendation: n4a encourages Congress and the Administration to pursue objective evaluation of the program, with careful consideration of lessons learned, appropriateness of metrics used and technical assistance for CBOs.

•  Prioritize Prevention and Wellness: The Prevention and Public Health Fund (PPHF) established under the Affordable Care Act is a critical investment in promoting wellness and preventing the diseases that are a primary driver of health care costs. Supporting evidence-based prevention and wellness programs for older adults is imperative, given the nation’s aging population and growing rates of chronic disease. More than 80 percent of Americans age 65 and older have at least one chronic condition, and half have at least two. Costs, both in terms of health care dollars and disability rates, are staggering. Among older adults, chronic conditions account for nearly 95 percent of health care expenditures and limit the activities of millions of people, decreasing their productivity and ability to live independently.

Lawmakers and administrators should build upon proven, cost-effective, evidence-based health promotion and disease prevention programs for older adults at the community level, including chronic disease self-management and falls prevention programs provided by the Aging Network under the Administration for Community Living’s (ACL) leadership. These programs deliver proven results and reduce Medicare and Medicaid costs.

Recommendation: n4a supports the Administration’s FY 2016 proposal to allocate $8 million of the PPHF to ACL for the Chronic Disease Self-Management Program, and we encourage Congress to again fund AoA falls prevention activities through the PPHF, at least meeting FY 2015’s level of $5 million.

•  Improve Mobility Options and Promote Community Living for All Ages: Available and accessible senior mobility and transportation services, which research has shown to be a critical factor in healthy and successful aging, is necessary to prepare America’s communities to meet the access and mobility needs of today’s and tomorrow’s older Americans.

Older Americans represent the fastest growing demographic in the country, and they have an increasing desire and need to access health and social services, to buy groceries, to participate in the workforce, to volunteer, to socialize with friends and neighbors—in other words, to “age in place” in their communities. Their ability to achieve this largely depends on access to transportation.

The Aging Network and others have seen escalating demand and interest from older adults in transportation and mobility services. In fact, in 2014, the number-one reason behind calls to the Eldercare Locator, a national information and referral resource funded by AoA and run by n4a, is seniors’ and caregivers’ transportation needs. This demand will grow tremendously with the aging of the baby boomer generation.

Recommendation: In order to ensure that older adults have adequate mobility options, n4a strongly encourages Congress and the Administration to provide dedicated, stable, sustainable funding through the Federal Transit Administration (FTA) for continued and expanded demonstration, outreach, and training and technical assistance activities, such as those previously and currently provided under the National Center on Senior Transportation (NCST; co-administered by n4a and Easter Seals), to meet the growing needs of the aging population. Also, we encourage the Administration to preserve the unique mission and role that the NCST has played in providing more intensive one-on-one support and grant funding to communities to seed the development of new options and approaches for meeting the mobility needs of older adults.

The rise in the number of aging citizens will also affect the social, physical and economic fabric of our nation’s cities and counties, dramatically affecting local policies, programs and services in the areas of aging, health and human services; land-use, housing and transportation; public safety and disaster planning; workforce and economic development; education and recreation; and volunteerism, lifelong learning and civic engagement.

Federal leadership in livable and sustainable communities is vitally needed, yet federal investments in promoting sustainable and livable communities has lagged significantly since 2010. In the meantime, states and local governments tasked with developing and implementing broad long-term community infrastructure and service systems have increasingly recognized the value of ensuring that these systems meet the needs of the ever-growing aging population. These community efforts will only be cost-effective and efficient if they reflect our aging reality.

Recommendation: A portion of new infrastructure spending should be directed to community agencies and nonprofit organizations to work with states and local governments to embrace livable-communities-for-all-ages principles and make them central to the core work of all government departments.

Erika Kelly

Meals on Wheels America

6/13/2015 12:05:14 AM

Meals on Wheels America commends the Administration and White House Conference on Aging (WHCOA) for this opportunity to share comments, as well as the continued efforts to promote and support healthy aging for all.

At this critical juncture in our nation’s history, when both the need and demand for nutritious meals for seniors are already substantial and will continue to climb exponentially, we must ensure that preventative, cost-effective programs such as Meals on Wheels are strengthened and properly resourced. We all know that without proper nutrition, one’s health deteriorates and can inevitably fail. For seniors, even a slight reduction in nutritional intake can exacerbate health challenges, increasing risk of hospitalization and/or long-term care.

Findings from the recently released More Than a Meal study showed that compared to a national representative sample of aging Americans, seniors on Meals on Wheels waiting lists are among our nation’s most vulnerable citizens. Specifically, the seniors who participated in this study were significantly more likely to:

•  Report poorer self-rated health (71% vs. 26%)
•  Screen positive for depression (28% vs. 14%) and anxiety (31% vs. 16%)
•  Report recent falls (27% vs. 10%) and fear of falling that limited their ability to stay active    (79% vs. 42%)
•  Require assistance with shopping for groceries (87% vs. 23%) and preparing food
•  (69% vs. 20%)
•  Have health and/or safety hazards both inside and outside the home (i.e., higher rates of tripping hazards, (24% vs. 10%), and home construction hazards, (13% vs. 7%)

Year after year, the gap between the number of seniors struggling with hunger and those receiving nutritious meals through programs such as Meals on Wheels continues to widen and waiting lists for services are mounting. Nationally, Older Americans Act Nutrition Programs have served 21 million fewer meals to seniors since 2005. This growing gap is due to declining federal, state and local resources; stagnant private funding; rising food and transportation and other increasing operational costs. At a minimum, it is critical that we stave off this continuous decline not only for the health of our seniors, but our nation as a whole.

There is no doubt that the 5,000+ nutrition programs supported through the Older Americans Act are making a significant social and economic difference. The nutritious meals, friendly visits, and safety and wellness checks these programs deliver each day are providing an efficient, effective and critical support service for our most vulnerable seniors, our families, our communities, and taxpayers as a whole. These programs enable seniors to live more nourished and independent lives longer in their own homes, reducing unnecessary visits to the emergency room and premature hospitalization and institutionalization. In fact, the cost of delivering Meals on Wheels to a senior for an entire year is about the same as just one day in a hospital or one week in a long-term care facility.

Simply put, ensuring that both today’s and tomorrow’s seniors receive the proper nutrition needed to maintain health and improve quality of life is not only an investment in our nation’s fiscal future, but is also a preventative prescription for significantly reducing Medicare and Medicaid expenses. We thank you again for this opportunity and your commitment to the needs of our nation's most vulnerable seniors.

Max

6/15/2015 5:32:26 AM

Aging is a cause of adult cancer, stroke, Alzheimers and other age related diseases.
The recent findings proves it (e.g. Critical dynamics of gene networks is a mechanism behind ageing and Gompertz law http://arxiv.org/abs/1502.04307 )
Based on compelling evidence Aging should be recognized as disease and treated as a diseases.
It is possible and is absolute need if we want to cure and prevent these diseases.
So the whole community fighting cancer stroke, Alzheimers and other age related diseases should channel their resources on aging itself, and not separate diseases as they do it now.
A lifespan of lab animals is increased 10folds (by genetic modifications - current world recored holder is Robert J. Shmookler Reis of University of Arkansas for Medical Sciences (UAMS)) and about 50% by interventions, there are dozens of animals that do not age including mammals (so called negligible senescence). At the same time aging research is seriously underfunded http://www.imminst.org/cureaging/ but fighting aging seems to be the only way to escape pension crisis since population is aging and healthcare costs are skyrocketing, but keeping people healhy and able for fruitful work for much longer than today will have a tremendous positive effect on economy.

Lindsey Copeland

Lutheran Services in America

6/15/2015 2:13:35 PM

LSA is a nationwide network of more than 300 Lutheran health and human services organizations that touch the lives of one in 50 Americans each year. Our members serve low-income, vulnerable people of all ages, faiths, and abilities in a variety of settings across the country. Nearly two-thirds of LSA member organizations provide services to older adults, including home and community-based services, such as adult day; case management; caregiver support; and senior nutrition services; as well as person-centered senior residential and facility-based care, including rehabilitation; health care; and respite.

LSA is committed to advancing the health, dignity, and independence older adults, their families, and caregivers.  We support policies that promote healthy aging, including through preventive programs that maximize seniors’ physical, mental, and social well-being; and those to prevent, identify, and respond to elder abuse and financial exploitation.  We recognize that an adequately financed, person-centered long-term services and supports delivery system is critical to improving health outcomes, well-being and quality of life; as is individual economic, retirement, and health security.

We appreciate the opportunity to comment, and respectfully submit the following policy recommendations for your consideration:

Healthy Aging

•  Count time spent in observation status towards the three-day prior hospitalization requirement to be eligible for the Medicare skilled nursing facility (SNF) benefit.

•  Build the capacity of the eldercare workforce and provide training in geriatric principles.

•  Implement and adequately fund innovative care coordination models that increase supports and provide caregiver training.

•  Make the Qualified Individual (QI) program and the Medicare improvement for Patients and Providers Act (MIPPA) low-income outreach and enrollment funding permanent.

•  Establish dementia as a qualifying event for the Medicare home health benefit.

Sarah Lovegreen

OASIS Institute

6/15/2015 4:43:33 PM

What do older adults and their families need to manage their chronic conditions and to optimize their physical, cognitive, and behavioral health?
Chronic conditions account for 75 percent of U.S. spending on health care.  Without more dedication to prevention, chronic conditions such as diabetes, heart disease and hypertension will increase by 30 to 40 percent over the next 15 years.

Evidence-based programs that build self-management skills to improve health are the strongest way to help older adults because they have demonstrated outcomes.  When these programs are offered in the community, older adults can support for each other and build their confidence to make lifestyle changes that improve health and independence.

These programs can be an even more powerful engine to keep people well through partnerships between healthcare providers and community-based organizations. Health providers are positioned to identify and refer people who can benefit from these programs. Community-based organizations like OASIS can offer these classes in familiar, easy-to-access neighborhood settings where participants can get necessary social support to make lasting changes.

The Health Foundation of South Florida, Partners in Care Foundation and others have demonstrated this by linking providers and community programs to promote health and prevent disease.  This is a strong model that should be replicated to connect adults in more communities with the right combination of services to manage their health.

Amy VanDeVelde

The OASIS Institute

6/17/2015 9:46:51 AM

The OASIS Institute is honored to be a part of the White House Conference on Aging Healthy Aging Policy Briefing.  My role at OASIS is to run our digital literacy initiative, Connections.
Low cost Internet access is one of the most important opportunities to help older Americans stay engaged and connected to their communities. Increasingly, people need to conduct personal business via the internet even in communities where access is not available in all homes.  If they lack skills to use technology they are at a greater risk of becoming isolated.
Older adults may appear hesitant to adopt new technologies but when the device, application or service has immediate relevance to a problem they need to solve and is within their financial means, they are eager and capable to do so.
In most situations, older Americans learn best when the training is from a patient teacher in a social setting.    While the advent of online training resources might appear to be an easy solution, in person training is optimal to assist seniors who experience the typical barriers to adopting technology.  These barriers include lack of experience with technology; living in a rural or underserved urban area with limited Internet access; changes to vision, hearing and dexterity that naturally occur as we age; and English as a second language.  Seventy seven percent of non internet users say that they would need help to learn to use a new device while 56 percent say they would need help to learn social media in order to stay in closer touch with loved ones.
Personal technology training to build digital literacy skills is critical to helping people age in place and is the most familiar learning experience they have. Learning with a group of peers in a community setting like a public library or a senior center provides an opportunity for older Americans to meet people in similar situations and reduce feelings of isolation in real time as they learn about using applications to connect with people online.  For people who are timid about technology, this is a more effective way to build skills and confidence than expecting people to figure out online training on their own.
John Horrigan, a leading researcher on technology adoption, stated that 50 percent of people over the age of 65 report that they are not doing as much as they would like to digitally.  Activities such as researching Medicare benefits, finding relevant health information and updating job skills are just a few of their needs.
Horrigan went on to say that eight to ten years ago older Americans reported that a primary barrier was getting online in the first place.  These days he hears more often that not having a smart phone or tablet is a barrier (John Horrigan speaking at The Project Goal Internet Safety for Older Adults Conference, February 10, 2015)  Since 2012 the number of people over 65 who own a cell phone has increased from 69 percent to 77 percent.  This is a trend that we have witnessed and responded to at the OASIS Institute during the past three years.
Aging Americans continue to have a strong desire to age in place and on their own terms.  Loss of ability to drive,  health complications or death of a spouse alter the aging in place scenario and leave older Americans more isolated than they may have anticipated.   Low cost Internet access and a means to help older Americans gain and maintain digital literacy are crucial to successful aging in the next decade.

Amy VanDeVelde

The OASIS Institute

6/17/2015 10:04:12 AM

Low cost Internet access is one of the most important opportunities to help older Americans stay engaged and connected to their communities. Increasingly, people need to conduct personal business via the internet even in communities where access is not available in all homes.  If they lack skills to use technology they are at a greater risk of becoming isolated.

Older adults may appear hesitant to adopt new technologies but when the device, application or service has immediate relevance to a problem they need to solve and is within their financial means, they are eager and capable to do so.

In most situations, older Americans learn best when the training is from a patient teacher in a social setting.    While the advent of online training resources might appear to be an easy solution, in person training is optimal to assist seniors who experience the typical barriers to adopting technology.  These barriers include lack of experience with technology; living in a rural or underserved urban area with limited Internet access; changes to vision, hearing and dexterity that naturally occur as we age; and English as a second language.  Seventy seven percent of non internet users say that they would need help to learn to use a new device while 56 percent say they would need help to learn social media in order to stay in closer touch with loved ones.

Personal technology training to build digital literacy skills is critical to helping people age in place and is the most familiar learning experience they have. Learning with a group of peers in a community setting like a public library or a senior center provides an opportunity for older Americans to meet people in similar situations and reduce feelings of isolation in real time as they learn about using applications to connect with people online.  For people who are timid about technology, this is a more effective way to build skills and confidence than expecting people to figure out online training on their own.

John Horrigan, a leading researcher on technology adoption, stated that 50 percent of people over the age of 65 report that they are not doing as much as they would like to digitally.  Activities such as researching Medicare benefits, finding relevant health information and updating job skills are just a few of their needs.

Horrigan went on to say that eight to ten years ago older Americans reported that a primary barrier was getting online in the first place.  These days he hears more often that not having a smart phone or tablet is a barrier (John Horrigan speaking at The Project Goal Internet Safety for Older Adults Conference, February 10, 2015)  Since 2012 the number of people over 65 who own a cell phone has increased from 69 percent to 77 percent.  This is a trend that we have witnessed and responded to at the OASIS Institute during the past three years.

Aging Americans continue to have a strong desire to age in place and on their own terms.  Loss of ability to drive,  health complications or death of a spouse alter the aging in place scenario and leave older Americans more isolated than they may have anticipated.   Low cost Internet access and a means to help older Americans gain and maintain digital literacy are crucial to successful aging in the next decade.

The OASIS Institute is honored to be a part of the White House Conference on Aging Healthy Aging Policy Briefing.  My role at OASIS is to run our digital literacy initiative, Connections.

Marc Lovett

6/27/2015 4:23:04 PM

I just assisted a 78 yr old friend w "memory problems" find an assisted care facility that could help keep him safe and maintain 'his vitality.  Living in Florida with so many fellow senior citizens, I assumed I would find all kinds of progressive and affordable options for my friend.  Not so, in fact I found the several facilities I visited to be appalling and unbelievably expensive.

Having had experience serving as a Guardian Ad Litem for several years, I was well aware of the ravages of poverty and hunger faced by so many of our younger children in Florida,  But at least that population is served on some level by the Department of Children and Family Services and the courts as well as by GALs.

Where is the equivalent care for equally helpless seniors?  None of the state's agencies were the least bit helpful to us nor did they seem interested in facilities that made "One Flew Over the Cuckoos Nest" seem like a story about a resort.

With a rapidly changing demographic shift toward a higher and higher percentage of "seniors" what's to come of the growing number of seniors who like my friend are becoming increasing dependent on the kindness of strangers just to survive? For starters how can we see that the facilities that pretend to provide skilled care for residents with "memory problems" are really held accountable to some set of enforced standards that at least preserve the dignity of those dependent on their services?.

Kate Doyle

Ms.

7/6/2015 5:28:57 PM

Regarding the question: Are there current healthy aging programs or policies you think are the most or least effective or potentially duplicative? - I would like to tell you about a Project that I have recently participated in, the Circle of Care Project. This is a 501(c) 3 nonprofit organization dedicated to providing accessibility to the arts, education and social/civic opportunities for the home-bound elder, senior facility residents and older adults with physical, cognitive and financial challenges. Circle of Care develops creative, sustainable ways of Aging in the Boulder Community.

I am a 62 year old disabled person who has been home-bound intermittently for 14 years. I have recently moved back to Boulder, CO with the hope that I could participate more in my community than I have in the past. I was made aware of the Circle of Care Project and along with 4 other seniors I was able to attend a wonderful concert at the Colorado Music Festival. The tickets were free and there were volunteers available to help us with out seating and transportation.

It may seem like a small thing to attend a concert, but I have not had the ability to go for many years. This was an incredible opportunity for all of us. Circle of Care allows seniors to access community events and to be an active part of the whole community. Many of the seniors that I know are in a low-income status and would not be able to attend any of the many artistic and educational events in our community without the generosity and leadership of the Circle of Care Project.

The Circle of Care Project is an important part of a comprehensive program for healthy aging and an innovative solution for Aging in Place. They have a National Best Practice designation by MetLife Foundation and they are on their radar.

Circle of Care is a concept that should be offered throughout the whole United States. Being a senior and disabled can create marginalization. Going to art, music, and educational events offers a sense inclusion. We all need and deserve this feeling.

Sally Bell

7/6/2015 6:26:11 PM

An important part of healthy aging is keeping the mind active and engaged as well, and for this, a community needs to make its cultural resources easily accessible to its older population. Symphonies, plays, movies, etc., keep minds active and help older people feel part of their communities. But many can no longer drive to them, or are on fixed incomes so can't afford them.

What to do?

My community of Boulder, Colorado has Circle of Care, www.circleofcareproject.org, which partners volunteers like me with several older people apiece to drive them to local cultural events, sit with them as a group, and make sure they are safe as well as entertained. They sign up for the events in which they are interested, as do the volunteers. Tickets are donated by the venue. You should see the participants sparkle after the performance! It's a chance to get dressed up, get out and experience quality cultural events with the rest of the community: going on now are the Colorado Shakespeare Festival and the Colorado Music Festival.

Circle of Care has a National Best Practice designation from MetLife Foundation, and is worthy of emulation in other cities.

Kathleen Spring

7/7/2015 1:22:32 AM

Healthy Aging goes hand-in-hand with Enjoying Life! What's the use of living a long time, if you cant enjoy your life.  One thing that happens to a lot of seniors, when they reach retirement age, is that they can no longer afford the things that gave them so much pleasure over the years because of reduced finances or lack of transportation.  I've seen seniors who use to attend not only every major concert and play in our area, but they attended the pre-shows, and discussion groups.  Now they are deprived of experiencing the beauty of "sound and sight" as well as the intellectual challenges.

Fortunately, in my area, a group in Colorado called Circle of Care Project (www.circleofcareproject.org) has stepped up to fill this gap. They seek out grants to pay for tickets, or seek out donations from organizations and people, and train volunteers to escort/transport the seniors to events multiple times a week.

They described themselves as:  We are part of a comprehensive approach for healthy aging and an innovative solutions for Aging in Place. We have a National Best Practice designation by the MetLife Foundation and are under the radar!
== their motto is: AGING IN COMMUNITY == Access to the Arts, Culture transportation, lifelong learning and community engagement are the assets that Circle of Care mobilizes to unite the generations and help keep older adults and our volunteers of all ages socially connected and living a vital, healthy, meaningful life. ==

I hope that other groups across the nation get in contact with them to see how they too can operate such an organization. And, I hope that this exposure will bring to Circle of Care new opportunities for organizational support and additional funding, so that they can continue to serve the area seniors for many years to come.

Steve Hirschhorn

7/7/2015 12:07:39 PM

A project that should be duplicated is Circle of Care Project www.circleofcareproject.org - as part of a comprehensive approach for healthy aging and an innovative solutions for Aging in Place. You must check this out! They are have a National Best Practice designation by the
MetLife Foundation and are under the radar! Signed Circle of Care Project
Volunteer Steve Hirschhorn.

Cherie Sajet

Circle of Care Project

7/7/2015 2:47:26 PM

My life changed the day that I found Circle of Care Project. When looking at healthy aging programs that could be duplicated nationally, you must check out Circle of Care Project. www.circleofcareproject.org.
COC received a Best Practice Designation from the MetLife Foundation in a publication called Stories for Change as well as numerous other awards for changing the way we age in community.

They unite the generations to support seniors, but also to support families, college students, caregivers through arts, education and cultural access. They have provided over 300,000 free door to door escorts through their volunteer transportation program. COC also provides free event tickets to high caliber cultural and community events and programs. This award winning program provides a great social support system as one ages in place. Both the volunteer escorts and senior riders get to attend amazing events! My financial situation would make this impossible otherwise.  One of my volunteer escorts has now become my dear friend and assists me in much of my daily life. This program is a game changer! An innovative senior community access  program which could be available to benefit seniors everywhere!

I now look further down the road than many seniors, since diagnosed with chronic, immune system disorders. I count myself lucky to live in a city that has numerous support systems in place for its aging population. Of course finding good quality affordable housing with alternative transportation options is at the top of everyone’s list. Circle of Care, an elder enrichment program, has transformed my world! When looking forward to a new day, week or month, I no longer think in terms of medical appointments, diagnostic tests, or the myriad routine chores that we all must attend to. Instead, I look forward to the movie, concert or play that I will be attending. Watching a live performance is transformative & energizing! I also anticipate the conversation I will have on the trip there & back. My mind wanders to seeing the many faces that have become familiar over this past year. What a welcome vacation from the ordinary, this interaction provides. Circle of Care has dramatically changed my life. I had a decent life before, but it can now be described as incredible! I often think back on my own parents & their isolation, as they grew older. How their lives would have benefitted from Circle of Care. This is an organizational model, which could be implemented in most areas of this country. What a difference this access makes to everyday lives!

•  What do older adults and their families need to manage their chronic conditions and to optimize their physical, cognitive, and behavioral health?
Access to decent health & dental care/services, timely follow up, support services. A low cost routine exercise program. Support services formulated to allow the elderly to remain in their own homes
•  How can we ensure that older adults know about, and take advantage of, the preventive services available to them under Medicare?
Send a publication to each new Medicare Enrollee, with an update every 2 years.  A yearly (standard of care) printed reminder guide for cardiac, gastroenterology, urology & well woman, general health to include annual physical exams & routine lab work. Annual teeth cleaning & every two-year vision check. This list is basic, without chronic conditions.
•  How can we provide more opportunities for older adults to stay engaged and connected to their communities?
Again, see Circle of Care website (www.circleofcareproject.org) Boulder, Colorado. Encourage models to be adopted nationwide. This improves quality of life & keeps seniors involved with their communities. When one is involved in this manner, connections become meaningful & seniors work toward being more active & involved. It is important to recognize that not all seniors have family members nearby who care or will assist.
•  Are there current healthy aging programs or policies you think are the most or least effective or potentially duplicative?
Circle of Care website. This program can be implemented nationally which would benefit all seniors aging in place. If there is any doubt as to the enormous role cultural events and music can play on overall health, see the documentary: Alive Inside. This is a vital connection that makes “free time” or retirement meaningful. Many seniors can no longer afford to travel, this offers a mini vacation to the routine of daily life, it encourages social interaction. After the necessity of shelter, transportaion & food are covered. Financially, entertainment is beyond the reach of many seniors, especially those in assisted living or group facilities without the benefit of long term care insurance. Circle of Care fulfills that void. Additionally, Circle of Care also assists seniors with auditing classes at nearby University of Colorado. Keeping the mind sharp & agile requires nourishment!
•  What steps can help Americans to live safely and comfortably in their homes and communities as they age?
Alternative transportation options to driving. Grocery shopping services. Meals on Wheels for post-op or rehab recovery.  Access to reduced rate exercise programs. Circle of Care Projects. Easy & affordable home repairs. Adequate federal nutritional benefits to include a daily source of fresh fruit & vegetables.
•  What additional actions could help ensure that older adults of all backgrounds can equally enjoy a long, productive, and healthy quality of life?
Quality of life is improved by participation. It is vital to make certain that elderly individuals can still feel connected to society, through worship and/or sharing community cultural events.

Donette Sparks

Circle of Care

7/7/2015 3:34:55 PM

Boulder Co. has a wonderful program called Circle of Care that helps to keep seniors engaged in their community and prevents depression caused by boredom. The program provides tickets with accompanying rides to concerts, films, outings in the mountains, ball games, auditing at both CU and Naropa University, etc. The program provides plenty of volunteers to assist seniors who need extra help and is a godsend for many seniors, especially low income seniors who could not afford to pay for all of those activities. Circle of Care, founded by Joan Raderman, takes hundreds of seniors on outings and has been very beneficial to many of us.

Judy Feland

Circle of Care Project

7/7/2015 5:39:36 PM

For over ten years I have been privileged to be a volunteer driver and a participant in a Circle of Care Project which is a Culture and Arts program begun by Joan Raderman in Boulder County, Colorado. Older adults who are low income and live at home or in Senior Residences that do not provide transportation are offered free tickets, companionship, and safety to attend a wide variety of local events.
I would love to see this program duplicated and funded throughout the U.S

Priscilla Gifford

Circle of Care Project, Boulder, CO

7/7/2015 9:36:21 PM

I am an 86-year-old woman living in the Golden West Senior Community in Boulder, CO., in an independent living studio apartment. I no longer drive.  My life has been greatly enriched by the Circle of Care Project, created and managed by Joan Raderman, which secures donated tickets to cultural events (symphony, Shakespeare plays, choral groups, films, theater, folk music, intergenerational poetry and art gatherings, nature experiences and many others.)
These are offered, free of charge, to seniors.  We do make a requested $5.00 donation. We are accompanied by trained volunteers and transported by bus or cars. Many use walkers or wheelchairs.

Many of us no longer drive, or are reluctant to drive after dark. Circle of Care keeps us connected with our vibrant Boulder community.  Many of us have developed friendships with the caring volunteers, and with Ms. Raderman, who founded the project about ten years ago.
Circle of Care serves a valuable purpose.  We are happily aging in place.

Laura

7/9/2015 12:48:07 AM

Are there current healthy aging programs or policies you think are the most or least effective or potentially duplicative?

Regarding a program which helps older Americans continue to live meaningful lives, Circle of Care Project - www.circleofcareproject.org - of Boulder, Colorado is an amazing organization. They have a comprehensive approach for healthy aging and innovative solutions for Aging in Place. This organization provides seniors accessibility to engage with the arts, education and civic opportunities. They also have a National Best Practice designation by the MetLife Foundation.

The experiences are wonderful and enriching for the seniors and the volunteers alike. This organization offers a way for seniors to continue enjoying their high quality of life.

Chaston

7/10/2015 5:32:26 PM

I have volunteered at circle of care events in the past and find them to be a great environment for seniors to engage in community activities. Here I was reminded of the great resource we have in our senior's experiences and knowledge. I believe it is in this environment that seniors were more willing to share. The activities create a great incentive for both parties and the program could be duplicated in other communities quite easily.

Trevor

7/9/2015 1:14:32 AM

Circle of Care in Colorado is a great program. Too often we believe that at a certain point you are "too old" to do things you once enjoyed, and instead should do things that are age-appropriate. Mental age is just as important as physical age. It is crucial to continue doing activities that you are passionate about as long as you are able. Circle of Care provides seniors accessibility to engage with the arts, education and civic opportunities in their community.

Tony Sarmiento

Senior Service America, Inc.

7/9/2015 10:15:20 AM

Senior Service America and its 81 local partner organizations in 16 states are pleased that the draft Healthy Aging policy brief highlights the Senior Community Service Employment Program (SCSEP) as well as the Senior Corps programs.

Fifty years ago, Congress and President Johnson launched these programs because they envisioned a Great Society in which poorer older Americans were willing and able to “deliver a triple win for America—at the intersection of healthy aging, economic security and social impact,” as described by the Encore Network in its paper for the 2015 WHCOA (See encore.org/.../WHCOA-paper-FINAL-4.14.2015.pdf).

Today, SCSEP, the Foster Grandparents Program, and Senior Companions Program enable more than 100,000 older Americans to deliver this “triple win” despite their low incomes and other disadvantages compared to their better-off peers.

SCSEP’s mission can be framed by the Encore Network’s “triple win”:
•  Healthy Aging: 91% of SCSEP participants reported that their physical health is the same or better than before they entered SCSEP, and 73% reported that their outlook on life is a little more or much more positive. (from an independent national survey of 10,668 participants funded by the US Department of Labor conducted by Charter Oak Group, 2014.)

•  Economic Security and Work: 45% of SCSEP participants exit into unsubsidized employment.(from USDOL official reports)

•  Social Impact: SCSEP participants provided more than 35.7 million staff hours to 30,000 local public and nonprofit agencies, such as libraries, schools, and senior centers last year. The value of these community service hours—using Independent Sector estimates—exceeded $806 million, nearly twice the total SCSEP appropriations of $432 million. Also, 76% of host agencies indicated that participation in SCSEP either significantly or somewhat increased their ability to provide services to the community (from an independent national survey of 7,446 agencies funded by USDOL conducted by Charter Oak Group, 2014.). Finally, through a two-year digital inclusion initiative, more than 550 SCSEP participants served as peer coaches in 354 sites and taught more than 25,000 older learners how to create and use an email account and search the Internet. (www.seniorserviceamerica.org)

In summary, SCSEP and Senior Corps are helping to make the encore movement more diverse and inclusive. Let’s build on these programs’ track records as models of innovation, scalability, and efficiency as we develop our national aging policy for the next decade.

James Appleby

The Gerontological Society of America

7/9/2015 5:51:14 PM

The Gerontological Society of America (GSA) has a long history of thought leadership in support of the once-a-decade White House Conference on Aging (WHCoA).  In anticipation of the 2015 WHCoA, GSA published special issues of The Gerontologist (http://oxford.ly/WHCOA15) and Public Policy & Aging Report (http://oxford.ly/WHCOA_PPAR) on the conference’s topics.  In that spirit, we submit our recommendations to this policy brief on Healthy Aging to build upon its strong and visionary foundation for effective policies that will benefit our aging society in the years ahead.

GSA applauds the steps taken to improve the lives of older adults through the programs described in the WHCoA’s policy brief on Healthy Aging.  The preventive health services included in the Affordable Care Act are important steps forward in creating a disease prevention orientation for consumers and clinicians alike.  Likewise, the proactive approach to managing chronic as described in the U.S. Department of Health and Human Services’ (HHS) “Multiple Chronic Conditions:  A Strategic Framework” report will be important as we strive to better manage the common conditions that frequently occur as adults age.

However, in order to enable older adults to have complete access to care options intended to prevent disease and reduce the morbidity associated with the chronic diseases of aging, GSA recommends the following:

1.  Provide coverage for immunizations recommended for routine use by the Advisory Committee for Immunization Practices (ACIP) under both Medicare Parts B and D.  Confusion resulting from coverage of some vaccines under Medicare Part B, and other vaccines under Medicare Part D, creates a barrier to patient access to vaccines which can prevent disease.

2.  Implement a clear and transparent process for adjusting Medicare coverage and reimbursement policies expeditiously so they align with ACIP recommendations.  Delays create an unnecessary barrier to improving immunization rates.

3.  Eliminate cost sharing for ACIP recommended vaccines.  Cost sharing causes an unnecessary financial and administrative barrier to greater vaccine uptake.

4.  Ensure in-network coverage of adult vaccinations administered in settings such as public health clinics and pharmacies.  Ensure HHS lays out federal requirements for adequate inclusion of local health departments and pharmacies in plan networks.

5.  Include coverage of FDA-approved medications to reduce weight in obese patients under Medicare Part D. More than one-third of older adults aged 65 and older are obese and the major chronic diseases of aging (Type 2 diabetes mellitus, arthritis, heart disease, hypertension, etc.) are all exacerbated by obesity.  The medical consequences of obesity are multi-factorial, but all are alleviated by modest achievable weight loss.

6.  Fully support implementation of the HHS National Pain Strategy and take steps to ensure coverage of comprehensive, interdisciplinary, multi-modal pain management strategies.

These recommendations reflect the input of GSA members, in connection with current projects GSA is leading in the areas of adult immunizations, obesity, and pain management.  We are the oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging.  Our principal mission — and that of our 5,500 members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. (For more information, see http://www.geron.org).

Jo Ann Jenkins

AARP

7/10/2015 10:34:30 AM

AARP is pleased to support the 2015 White House Conference on Aging (WHCoA) on July 13. Beginning with the first conference in 1961 and for each one since, AARP has offered strong support because the sessions not only shine a spotlight on issues related to aging in America but also lead to practical solutions that make life better for people as they age.

The conferences have introduced innovative ideas such as universal home design features that allow people to live at home safely and independently, and practical ideas for abolishing mandatory retirement and creating cost-of-living adjustments for Social Security payments. Many credit that first WHCoA with leading to the enactment of Medicare and Medicaid and the Older Americans Act 50 years ago this month.

Click here to see where we stand:

blog.aarp.org/.../

Susan McWhinney-Morse and Hal Carroll

Beacon Hill Village

7/10/2015 6:43:47 PM

This is a year rich in commemoration for aging Americans, with significant anniversaries for Social Security, Medicare and Medicaid, and the Older Americans Act itself.  Each of these will continue to be a vital building block in helping all Americans age healthily and in reasonable financial security.

No less important for healthy aging, though, is community, and the village model - a private initiative - stands out.  Beacon Hill Village (BHV) was founded in 2001 by a group of Boston neighbors committed to staying in their own homes and community as they aged.  BHV has achieved national and international coverage for its path-breaking innovation.  More importantly, it has been a practical inspiration to community activists across America.  In the early years, BHV itself provided the technical assistance to help new villages open.  Today, that technical assistance is largely provided through the Village to Village Network (VTVN) which BHV helped to found in 2009.  More than 160 VTVN member villages provide services to and create community connections for more than 25,000 members today.  And many more aspiring VTVN villages are in formation.

BHV and its fellow members of VTVN could not be more timely.  Every day an average of 10,000 baby boomers reaches 65; the first boomers are 69 this year, and are heading soon to the age when they will want to join existing villages or create villages of their own.  Survey after survey shows Americans overwhelmingly want to remain in their own homes and communities as they age.  Thriving villages already are supporting such aging Americans now.  There's every reason to believe villages will only be more important to aging Americans in the future.

Of the four thematic concerns of WHCOA 2015, villages address three of them.

Villages, of course, are all about healthy aging.  They nourish their members in body, mind and soul.  And they can provide myriad ways for members to sustain existing ties with each other and develop rewarding new ties as well.  Perhaps most important, villages can help their members and the public at large see that for most aging Americans much of the time, aging is not a fateful burden but an exciting opportunity, a time not for giving up but for giving back.

Villages already provide or connect their members with many services often not obtainable through government or private social service agencies.  And many are eager to find new roles they can play in their communities as health care becomes more and more outpatient- and even home-based.

And because villages are powerful communities themselves, they do now, and will be able to in the future, help their members lead secure and safe lives.  Villages are active information hubs that can keep their members up to date about the latest scam.  And their emphasis on keeping up and expanding each member's social life can be a powerful antidote to elder abuse, which is so often correlated with elder isolation.

Of course, BHV is proud of its own success, and proud of the village successes across America and throughout the world which it has inspired.  But others' accolades may mean more.  A late 2005 article in the AARP Bulletin and an early 2006 article in The New York Times introduced BHV to America (www.nytimes.com/.../09care.html) .   Last year an article in Forbes said finding a village was one of the best things Americans age 50+ could do for themselves and their aging parents (www.forbes.com/.../).  And BHV and the village movement have had important recent television coverage on CBS (www.cbsnews.com/.../) and PBS (www.pbs.org/.../).  These are only the highlights of extensive coverage that describe the village model as one important solution to the long-term care crisis in America and how older adults are creating opportunities for themselves and their contemporaries to choose how they live as they age and change how aging is valued by our culture.

America cannot build its way out of its impending boomer retirement years.  Most Americans cannot afford assisted living and even those who can usually want to defer it as long as possible.  Villages can be a vital support to both.  We urge conference attendees to recognize what villages have already accomplished for their members, and how valuable access to a village could be to every aging American.

Sincerely,

Hal Carroll, BHV President

Susan McWhinney-Morse, Founding BHV Board Member and VTVN Board Member

Becky Roe

7/13/2015 8:34:53 AM

On the question of how to ensure that older adults know about, and take advantage of, the preventive services available to them under Medicare?

Working with the older adult population for several year's and being a volunteer for the State's SHIP (State Health Insurance Information Program) program, I discuss with the individual preventive programs available under the Medicare program as well as other preventive services should they have a supplemental or the Medicare Advantage plan. Since the State's SHIP programs are grant funded by the state, I have found that many older adults are not aware this free service exists. I have also found that not all calls made to CMS are constructive in the area of educating the individual. I am a firm believer of the hands on approach as well as community meetings or brochures provided by CMS to explain the preventive services programs. I have a full-time position that works with the public sector on Medicare issues but these mostly relate to billing and invoicing needs. I think if we can reach the older population where they live and send them information brochures, newsletters, or a monthly updates when their Medicare statements you can reach a larger population. Since the federal government can only reach many through CMS, it then becomes a larger burden on CMS to educate via phone which is not very conducive to the older population understanding the preventive programs offered.

Ray Sears

7/18/2015 6:51:18 PM

What are the three things that all people experience as they age. First, we can't hear so well. Next, we can't see so good. Lastly, our teeth go to hell. I am sure that people smarter than myself, can attribute all sort of negative health outcomes due to the conditions I described. I am on Medicare and am very impressed with the assistance it provides. I would ask that this program be expanded to cover dental, vision, and hearing services so I can maintain the same quality of life as our younger citizens. Does this make too much sense? Please do not tell me it is too costly. There is plenty of money in the Federal budget, it is just a matter where you choose to spend it. Thanks.
Ray Sears
Iowa

James Appleby

The Gerontological Society of America

7/22/2015 10:22:15 AM

The Gerontological Society of America (GSA) has a long history of thought leadership in support of the once-a-decade White House Conference on Aging (WHCoA).  In anticipation of the 2015 WHCoA, GSA published special issues of The Gerontologist (http://oxford.ly/WHCOA15) and Public Policy & Aging Report (http://oxford.ly/WHCOA_PPAR) on the conference’s topics.  In that spirit, we submit our recommendations to your Policy Brief on Healthy Aging to build upon its strong and visionary foundation for effective policies that will benefit our aging society in the years ahead.

GSA applauds the steps taken to improve the lives of older adults through the programs described in the WHCoA’s Policy Brief on Healthy Aging.  The preventive health services included in the Affordable Care Act are important steps forward in creating a disease prevention orientation for consumers and clinicians alike.  Likewise, the proactive approach to managing chronic as described in the U.S. Department of Health and Human Services’ (HHS) “Multiple Chronic Conditions:  A Strategic Framework” report will be important as we strive to better manage the common conditions that frequently occur as adults age.

However, in order to enable older adults to have complete access to care options intended to prevent disease and reduce the morbidity associated with the chronic diseases of aging, GSA recommends the following:

1.  Provide coverage for immunizations recommended for routine use by the Advisory Committee for Immunization Practices (ACIP) under both Medicare Parts B and D.  Confusion resulting from coverage of some vaccines under Medicare Part B, and other vaccines under Medicare Part D, creates a barrier to patient access to vaccines which can prevent disease.

2.  Implement a clear and transparent process for adjusting Medicare coverage and reimbursement policies expeditiously so they align with ACIP recommendations.  Delays create an unnecessary barrier to improving immunization rates.

3.  Eliminate cost sharing for ACIP recommended vaccines.  Cost sharing causes an unnecessary financial and administrative barrier to greater vaccine uptake.

4.  Ensure in-network coverage of adult vaccinations administered in settings such as public health clinics and pharmacies.  Ensure HHS lays out federal requirements for adequate inclusion of local health departments and pharmacies in plan networks.

5.  Include coverage of FDA-approved medications to reduce weight in obese patients under Medicare Part D. More than one-third of older adults aged 65 and older are obese and the major chronic diseases of aging (Type 2 diabetes mellitus, arthritis, heart disease, hypertension, etc.) are all exacerbated by obesity.  The medical consequences of obesity are multi-factorial, but all are alleviated by modest achievable weight loss.

6.  Fully support implementation of the HHS National Pain Strategy and take steps to ensure coverage of comprehensive, interdisciplinary, multi-modal pain management strategies.

These recommendations reflect the input of GSA members, in connection with current projects GSA is leading in the areas of adult immunizations, obesity, and pain management.  We are the oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging.  Our principal mission — and that of our 5,500 members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. (For more information, see http://www.geron.org).

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Healthy Aging Policy Brief

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