Older Americans Act (OAA) review

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Medicine

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Feb 20, 2024

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1. Ideally, the Title I objectives, if successful, should increase the availability and ease of access to healthcare and resources for older adults. The effects limited resources have on this vulnerable population are a considerable focus for aging interventions. The 75+ age group accounted for approximately half of the deaths that occurred in New Orleans, Louisiana as a result of Hurricane Katrina (Wacker and Roberto, 2019). Limited resources pose a challenge for the success of Title I objectives, however, one could argue that with proper funding and government assistance it can be overcome. That is, if the budget allows. When questioning the realistic nature of program success, the budget and financial summary are of great interest. In 2019, the budget for the OAA was $2.06 billion. In 2021, the budget was $2.13 billion (Mackey, 2021). Full funding for the OAA in fiscal year 2022 calls for $2.46 billion and the reauthorization budget includes a 7% increase in the first year and 6% increase every year for the next four years (Wacker and Roberto, 2019). These budget increases lend to the attainability of Title I objectives. However, these budget increases are not guaranteed. One article stated: “Programs under OAA are discretionary and subject to the annual appropriations process, meaning Congress may not provide the full increase allowed for in the reauthorization.” (Mackey, 2021). The budget for OAA in 2017 was only $1.4 billion dollars. In 2019, $2.05 billion. In 2021, $2.13 billion. We have seen consistent budget increases, but is this sustainable? 2 . I find some of the policy objectives to be a bit far-fetched. For example, the first objective includes: “an adequate income in retirement in accordance with the American standard of living” (Wacker and Roberto, 2019). I think it is far-fetched to say that every older adult should be living comfortably to an “American standard” when there is an overwhelming number of older adults suffering due to lack of resources. That being said, they address important areas such as mental health services and restorative care in long term care facilities. 3. 1. An adequate income in retirement in accordance with the American standard of living 5 Individuals over 65 receive approximately 45% of their income through Social Security (Center on Budget and Policy Priorities, 2020). 97% of the elderly currently receive or will receive Social Security (Center on Budget and Policy Priorities, 2020). I ranked this objective a 5 because even though most older adults rely on Social Security for income, the average benefit was $1,514 for the month of June in 2020. Not to mention, most recipients opt for Medicare Part B and have their premiums deducted from their benefit amount. 2. The best possible physical and mental health that science can make available, without regard to economic status 3 Individuals with low-income often rely on Medicaid insurance to cover the cost of these renowned physical and mental health services. Medicaid networks are limited, especially in

rural areas where they are needed most. Medicaid patients are also scheduled differently because providers limit the number of Medicaid patients they see. For example, when scheduling an appointment for my resident who has a private supplementary insurance to Medicare, they were able to see her that week. When scheduling with this same provider for a patient with Medicaid, the next available appointment wasn’t for another 5 weeks. The best possible care seems far-fetched when these individuals don’t have equal access. 3. The provision and maintenance of suitable housing, independently selected, designed, and located with reference to special needs and available at costs that older citizens can afford 6 Based on my experience in social services, affordable and accessible housing resources have significantly increased in the recent years. I chose to rank this at a 6 because it has improved for our area but is usually limited to larger cities. 4. Full restorative services for those who require institutional care and a comprehensive array of community-based long-term care services adequate to appropriately sustain older people in their communities and in their homes, including support to family members and other persons providing voluntary care to older individuals needing long-term care services 7 I ranked this objective a 7 because we recently implemented a more in-depth restorative program for our long-term residents to include quarterly assessments and comprehensive screenings. Medicare offers reimbursement for facilities that provide restorative care for 15 minutes twice a day for 6 days a week. I actually worked as our restorative aide prior to becoming the Social Services Director. I received a written restorative nursing program from our therapists who would walk me through the different range of motion exercises. I would assist or supervise and ensure these programs were completed. We currently do not have a restorative aide and rely on our nurses and certified nursing assistants (CNAs) to complete these programs. I often find that they are not actually being done. 5. Opportunity for employment with no discriminatory personnel practices because of age 7 I ranked this a 7 based on my own experience. I work with several elderly individuals, including one CNA who is 62 and a fellow department head who is 74. The Age Discrimination in Employment Act (ADEA) and the Senior Community Service Employment Program (SCSEP) appear effective at addressing this. 6. Retirement in health, honor, and dignity after years of contribution to the economy 5 I am uncertain about this. I find it odd that it was included as an objective because it is difficult to address. I am interested to see what others ranked the latter and why. I don’t feel that this belongs but am open-minded to explanations. 7. Participation in and contribution to meaningful activity within the widest range of civic, cultural, and recreational opportunities 6 Senior centers, adult day care centers, long term care facilities, et cetera, all include activities based on assessments. There are typically senior centers in every county. I searched for state regulations regarding the Title I objectives to see if there were any that specified activities and

discovered that Florida does not have any state regulations related to these objectives (see: https://www.law.cornell.edu/uscode/text/42/3001 ). 8. Efficient community services, including access to low-cost transportation, that provide a choice in supported living arrangements and social assistance in a coordinated manner and that are readily available when needed, with emphasis on maintenance of a continuum of care for vulnerable older individuals 2 Again, this is based on personal experience, however, transportation seems to be one of the most challenging services to coordinate for older adults. 9. Immediate benefit from proven research knowledge that can sustain and improve health and happiness 1 I am excited to see where the world of cognition research expands to. 10. Freedom, independence, and the free exercise of individual initiative for older adults in planning and managing their own lives, full participation in the planning and operation of community-based services and programs provided for their benefit, and protection against abuse, neglect, and exploitation 8 4. I think private sectors get a bad reputation because of the lower quality of care observed in government facilities. The purpose of the OAA is to contribute to the health and independence of older adults by funding critical services that many do not have access to. However, it is important that we note that a percentage of wealthier older adults do have reasonable access. As discussed previously, limited resources will pose a challenge for the success of the OAA. Partnering with private sectors offers an opportunity to suit the needs and/or desires of older adults with various living standards. Objective #1 of the Title I objective states that older adults should be able to live comfortably up to the American standard and I don’t foresee that happening in a government funded facility based on my experience in Leon, Wakulla and Franklin County. The question is, how much will this contribute to other OAA funded programs? Will a standard level of care be possible to achieve? Cost-sharing should be carefully considered. I have seen this in practice with Medicaid enrollees. Florida has established out of pocket spending requirements for these individuals. There is a considerable outcome that our book briefly touches on and that is hindering the extremely needy individuals from receiving care. If cost-sharing/out of pocket spending requirements are truly income based, wouldn’t that be accounted for? If Medicare intends to follow the same cost-sharing requirements it may encourage participants to seek unnecessary medical care to meet premiums and possibly contribute to fund exhaustion. What I am noticing has not been addressed is Objective #2: “the best possible physical and mental health that science can make available, without regard to economic status”. And Objective #9: “immediate benefit from proven research knowledge that can sustain and improve health and happiness”. The best possible care requires further research tailored to the geriatric population. The FDA does not yet recognize aging as a disease because it is considered

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too broad and aging and death are accepted as a normal function of life. The FDA’s support would be instrumental to further aging research. Another issue is the structure of our healthcare system is designed to treat illness, not wellness. First proposed by George Engel in 1977, the biopsychosocial (BPS) model of medicine aims to address the latter by incorporating psychological and social factors to patient treatment and emphasizing the importance of patient-centered care and patient-provider relationships (Jaini & Lee, 2015). Almost 40 years later and a whopping 5 allopathic medical schools currently utilize the BPS model (one just happens to be my Alma Mater, Florida State University). The OAA reauthorization does emphasize the importance of social isolation interventions and introduces vulnerable and at-risk patients as targets. Prior to COVID-19 were little considerations for the effects of loneliness and social isolation on older adults, however the latter put patients at risk for mortality and contributes to cognitive decline. The Senior Community Service Employment Program (SCSEP) increases opportunities for employment for seniors, consistent with objective #5. References Evans, I., Llewellyn, D. J., Matthews, F. E., Woods, R. T., Brayne, C., Clare, L., & CFAS-Wales research team (2018). Social isolation, cognitive reserve, and cognition in healthy older people. PloS one , 13 (8), e0201008. https://doi.org/10.1371/journal.pone.0201008 Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta- analytic review. Perspectives on psychological science : a journal of the Association for Psychological Science , 10 (2), 227–237. https://doi.org/10.1177/1745691614568352 Jaini, P. A., & Lee, J. S. (2015). A Review of 21st Century Utility of a Biopsychosocial Model in United States Medical School Education. Journal of lifestyle medicine, 5(2), 49–59. https://doi.org/10.15280/jlm.2015.5.2.49 Policy basics: Top Ten facts about social security. Center on Budget and Policy Priorities. (August 13, 2020). https://www.cbpp.org/research/social-security/top-ten-facts-about-social- security. Mackey, R. (2021, August 30). Fully fund the Older Americans act (oaa). NACo. https://www.naco.org/resources/fully-fund-older-americans-act-oaa. Wacker, R. R., & Roberto, K. A. (2019). Community resources for older adults: Programs and services in an era of change. SAGE Publications, Inc.

Older Americans Act (OAA) review

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